Healthcare Provider Details

I. General information

NPI: 1720942790
Provider Name (Legal Business Name): RACHEL PATRICIA TIEVY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 LOCH RAVEN BLVD
BALTIMORE MD
21239-2950
US

IV. Provider business mailing address

17103 TITUS WAY
POOLESVILLE MD
20837-2180
US

V. Phone/Fax

Practice location:
  • Phone: 443-296-1753
  • Fax:
Mailing address:
  • Phone: 240-722-8696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: