Healthcare Provider Details

I. General information

NPI: 1508020348
Provider Name (Legal Business Name): TARYN WINKLE M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2008
Last Update Date: 06/19/2020
Certification Date: 06/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 W MAC PHAIL RD ST SUITE 107
BEL AIR MD
21014
US

IV. Provider business mailing address

602 ATWWOD ROAD SUITE 104
BEL AIR MD
21014
US

V. Phone/Fax

Practice location:
  • Phone: 410-838-9555
  • Fax: 410-836-5056
Mailing address:
  • Phone: 410-838-9555
  • Fax: 410-838-5006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD78871
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA101625
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: