Healthcare Provider Details

I. General information

NPI: 1174705453
Provider Name (Legal Business Name): PYRAMID PHYSICAL MEDICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2007
Last Update Date: 11/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9309 BELAIR RD 1ST FLOOR
BALTIMORE MD
21236-1608
US

IV. Provider business mailing address

9309 BELAIR RD 1ST FLOOR
BALTIMORE MD
21236-1608
US

V. Phone/Fax

Practice location:
  • Phone: 410-256-8511
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberS01350
License Number StateMD

VIII. Authorized Official

Name: DR. BRIAN REGAN
Title or Position: OWNER
Credential:
Phone: 410-256-8511