MEDICARE: PROTOCOL, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1841015021
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROTOCOL, LLC

Provider Business Mailing Address
First Line	:	1301 YORK RD
Second Line	:
City	:	LUTHERVILLE
State	:	MD
Zip	:	21093-6035
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000 N MONROE ST
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21217-1316
Country	:	US
Telephone Number	:	443-760-2264
Fax Number	:

Authorized Official
Title or Position	:	OWNER/FOUNDER
Name	:	DEVANTE M TEEL
Credential	:
Telephone Number	:	443-515-9157

Provider Enumeration Date	:	11/21/2024
Last Update Date	:	01/15/2025

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Directions to “PROTOCOL, LLC ” Practice Location

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