MS. THERESA L DEMATTEO PUGH MS CRNP NPI 1841390713

NPI Information

  • NPI: 1841390713
  • Provider Name: MS. THERESA L DEMATTEO PUGH, MS CRNP
  • Classification: Nurse Practitioner - 363LP0200X
  • Specialization: Pediatrics
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 4924 CAMPBELL BLVD
    SUITE 200
    NOTTINGHAM, MD
    ZIP 21236
  • Phone: (443) 442-2300

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NPI Details

MS. Theresa L Dematteo Pugh, MS CRNP is a pediatrics nurse practitioner in Nottingham, MD. MS. Theresa L Dematteo Pugh, MS CRNP NPI is 1841390713. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

4924 CAMPBELL BLVD
SUITE 200
NOTTINGHAM, MD
ZIP 21236-908
Phone: (443) 442-2300
Fax: (443) 442-2360

The NPI 1841390713 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 9/22/2006 and was last updated on 5/9/2013.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363LP0200XNurse PractitionerPediatricsR076644MARYLANDYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1R13077MEDICARE UPIN
2A095MEDICARE ID-TYPE UNSPECIFIED
3622361300MEDICAIDMARYLAND

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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