Healthcare Provider Details

I. General information

NPI: 1609849769
Provider Name (Legal Business Name): BEVERLY ANN TYLER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 PLUMTREE ROAD SUITE 115
BEL AIR MD
21015-5901
US

IV. Provider business mailing address

104 PLUMTREE RD STE 115
BEL AIR MD
21015-6095
US

V. Phone/Fax

Practice location:
  • Phone: 410-515-4300
  • Fax: 410-515-4318
Mailing address:
  • Phone: 410-515-4300
  • Fax: 410-515-5170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0034255
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: