Healthcare Provider Details

I. General information

NPI: 1467376129
Provider Name (Legal Business Name): TYNEE RIDGLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 CATHEDRAL STREET SUITE L3
BALTIMORE MD
21201
US

IV. Provider business mailing address

520 WYANOKE AVE APT 1
BALTIMORE MD
21218-2072
US

V. Phone/Fax

Practice location:
  • Phone: 301-458-8051
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number35238
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: