Healthcare Provider Details

I. General information

NPI: 1699911578
Provider Name (Legal Business Name): PAMELA TECCE JOHNSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAMELA MARY TECCE MD

II. Dates (important events)

Enumeration Date: 12/26/2008
Last Update Date: 11/11/2022
Certification Date: 11/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 N CAROLINE ST ROOM 3140D
BALTIMORE MD
21287-0006
US

IV. Provider business mailing address

6201 GREENLEIGH AVE
MIDDLE RIVER MD
21220-2004
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-9446
  • Fax: 410-614-0341
Mailing address:
  • Phone: 410-933-6423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberD47191
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: