Healthcare Provider Details

I. General information

NPI: 1477670248
Provider Name (Legal Business Name): DYER P. BILGRAVE PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6525 N CHARLES ST SUITE 237
BALTIMORE MD
21204-6872
US

IV. Provider business mailing address

418 NORTHWAY
BALTIMORE MD
21218-1115
US

V. Phone/Fax

Practice location:
  • Phone: 443-562-8331
  • Fax:
Mailing address:
  • Phone: 443-562-8331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number04014
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number04014
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: