Healthcare Provider Details

I. General information

NPI: 1417709643
Provider Name (Legal Business Name): MR. DARRYL ROBERT LINDSEY JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2024
Last Update Date: 04/02/2024
Certification Date: 04/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4669 FALLS RD
BALTIMORE MD
21209-4914
US

IV. Provider business mailing address

4669 FALLS RD
BALTIMORE MD
21209-4914
US

V. Phone/Fax

Practice location:
  • Phone: 410-662-8606
  • Fax: 410-662-8608
Mailing address:
  • Phone: 410-662-8606
  • Fax: 410-662-8608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number933155077
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: