Healthcare Provider Details

I. General information

NPI: 1255976874
Provider Name (Legal Business Name): TUERK HOUSE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2019
Last Update Date: 11/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 N ASHBURTON ST
BALTIMORE MD
21216-4703
US

IV. Provider business mailing address

730 N ASHBURTON ST
BALTIMORE MD
21216-4703
US

V. Phone/Fax

Practice location:
  • Phone: 667-212-3626
  • Fax: 443-708-5114
Mailing address:
  • Phone: 667-212-3626
  • Fax: 443-708-5114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: VANESSA LYLE
Title or Position: BILLING SPECIALIST
Credential:
Phone: 672-123-6266