Healthcare Provider Details

I. General information

NPI: 1720414493
Provider Name (Legal Business Name): HOWARD COUNTY CENTER FOR LUNG AND SLEEP MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2013
Last Update Date: 09/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10910 LITTLE PATUXENT PKWY SUITE 100
COLUMBIA MD
21044-3081
US

IV. Provider business mailing address

10910 LITTLE PATUXENT PKWY SUITE 100
COLUMBIA MD
21044-3081
US

V. Phone/Fax

Practice location:
  • Phone: 410-740-3635
  • Fax: 410-740-1253
Mailing address:
  • Phone: 410-740-3635
  • Fax: 410-740-1253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State

VIII. Authorized Official

Name: LAURA NYANJOM
Title or Position: OFFICE MANAGER
Credential:
Phone: 410-740-3635