Provider Demographics
NPI:1538433669
Name:ILAGAN, BENJAMIN OGALESCO III (PT)
Entity type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:OGALESCO
Last Name:ILAGAN
Suffix:III
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 CLEAR VIEW CT
Mailing Address - Street 2:
Mailing Address - City:CHURCHVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21028-1606
Mailing Address - Country:US
Mailing Address - Phone:410-734-4818
Mailing Address - Fax:
Practice Address - Street 1:200 CLEAR VIEW CT
Practice Address - Street 2:
Practice Address - City:CHURCHVILLE
Practice Address - State:MD
Practice Address - Zip Code:21028-1606
Practice Address - Country:US
Practice Address - Phone:410-734-4818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-07
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18395225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist