Healthcare Provider Details

I. General information

NPI: 1215436274
Provider Name (Legal Business Name): TERRI LYNN BUZBY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2018
Last Update Date: 02/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10440 LITTLE PATUXUENT PKWY 800
COLUMBIA MD
21044
US

IV. Provider business mailing address

10440 LITTLE PATUXENT PKWY SUITE 800
COLUMBIA MD
21044
US

V. Phone/Fax

Practice location:
  • Phone: 443-518-9368
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR137515
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: