Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | D0057432 | MD |
NPI | 1124020714 |
---|---|
Provider Name | Dr. Colleen C Cagle |
First Address | Frederick, MD 21702-4747 |
Second Address | Frederick, MD 21702-4747 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2005 |
Last Update Date | 30/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
812203200 | (05) | MD |