Provider Demographics
NPI:1053740399
Name:RUNGE, NIKI (MT-BC)
Entity type:Individual
Prefix:
First Name:NIKI
Middle Name:
Last Name:RUNGE
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 E MAIN ST
Mailing Address - Street 2:SUITE 211
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-5102
Mailing Address - Country:US
Mailing Address - Phone:443-523-4976
Mailing Address - Fax:410-546-2376
Practice Address - Street 1:212 E MAIN ST
Practice Address - Street 2:SUITE 211
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-5102
Practice Address - Country:US
Practice Address - Phone:443-523-4976
Practice Address - Fax:410-546-2376
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD5585503900Medicaid