Healthcare Provider Details

I. General information

NPI: 1003888322
Provider Name (Legal Business Name): TOTAL IMAGE CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 04/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9103 FRANKLIN SQUARE DR SUITE 1700
BALTIMORE MD
21237-3900
US

IV. Provider business mailing address

800 ARMY RD
TOWSON MD
21204-6701
US

V. Phone/Fax

Practice location:
  • Phone: 443-777-6302
  • Fax: 443-777-6309
Mailing address:
  • Phone: 410-560-0614
  • Fax: 410-560-0613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. EDWARD J KELLY III
Title or Position: CEO
Credential:
Phone: 410-560-0614