Healthcare Provider Details

I. General information

NPI: 1528438033
Provider Name (Legal Business Name): DARRYL TALLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2015
Last Update Date: 01/04/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 N MONROE ST
BALTIMORE MD
21223-1641
US

IV. Provider business mailing address

115 N MONROE ST
BALTIMORE MD
21223-1641
US

V. Phone/Fax

Practice location:
  • Phone: 410-744-7076
  • Fax:
Mailing address:
  • Phone: 410-744-7076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number02163
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: