Provider Demographics
NPI:1548876089
Name:KOOGLE, EMILY
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:KOOGLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8409 STONEHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-2367
Mailing Address - Country:US
Mailing Address - Phone:240-315-4536
Mailing Address - Fax:
Practice Address - Street 1:1734 MARYLAND AVE STE 200
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-5804
Practice Address - Country:US
Practice Address - Phone:877-674-2843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician