Healthcare Provider Details

I. General information

NPI: 1407411085
Provider Name (Legal Business Name): ALEXANDRIA M B THIELMEYER PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2019
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 N BROADWAY
BALTIMORE MD
21205-1832
US

IV. Provider business mailing address

707 N BROADWAY
BALTIMORE MD
21205-1832
US

V. Phone/Fax

Practice location:
  • Phone: 443-923-1842
  • Fax:
Mailing address:
  • Phone: 317-249-2242
  • Fax: 317-663-1175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number07531
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: