Healthcare Provider Details

I. General information

NPI: 1043536337
Provider Name (Legal Business Name): TIMOTHY GLENN PARKER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2010
Last Update Date: 04/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 FRANKLIN SQUARE DR DEPARTMENT OF PEDIATRICS
BALTIMORE MD
21237-3901
US

IV. Provider business mailing address

9000 FRANKLIN SQUARE DR DEPARTMENT OF PEDIATRICS
BALTIMORE MD
21237-3901
US

V. Phone/Fax

Practice location:
  • Phone: 443-777-7128
  • Fax: 443-777-7130
Mailing address:
  • Phone: 443-777-7128
  • Fax: 443-777-7130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC01309
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: