Healthcare Provider Details

I. General information

NPI: 1356246342
Provider Name (Legal Business Name): BETHANY TILLAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2026
Last Update Date: 10/10/2026
Certification Date: 10/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 MEDICAL PKWY STE 306
ANNAPOLIS MD
21401-3745
US

IV. Provider business mailing address

758 KIMBERLY WAY
STEVENSVILLE MD
21666-2402
US

V. Phone/Fax

Practice location:
  • Phone: 410-571-9700
  • Fax:
Mailing address:
  • Phone: 443-844-5494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberR256830
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: