Healthcare Provider Details

I. General information

NPI: 1962807867
Provider Name (Legal Business Name): TYLER RICKARDS PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2014
Last Update Date: 01/02/2024
Certification Date: 01/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N WOLFE ST MEYER 1-163
BALTIMORE MD
21287-0005
US

IV. Provider business mailing address

5051 GREENSPRING AVE STE 300
BALTIMORE MD
21209-4358
US

V. Phone/Fax

Practice location:
  • Phone: 814-330-7464
  • Fax:
Mailing address:
  • Phone: 410-601-1958
  • Fax: 410-601-7828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number05665
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number05665
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: