Provider Demographics
NPI:1871576108
Name:HUNGATE, JANE H (PHD)
Entity type:Individual
Prefix:DR
First Name:JANE
Middle Name:H
Last Name:HUNGATE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2810 ELLIOTT ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-4856
Mailing Address - Country:US
Mailing Address - Phone:410-732-8550
Mailing Address - Fax:410-732-4346
Practice Address - Street 1:3016 ODONNELL ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-4915
Practice Address - Country:US
Practice Address - Phone:443-691-3342
Practice Address - Fax:410-732-4346
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD078411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD593RMedicare ID - Type Unspecified
MDR13185Medicare UPIN