Healthcare Provider Details

I. General information

NPI: 1407841059
Provider Name (Legal Business Name): INTERACTIVE SOFTWARE IN MEDICINE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 01/10/2025
Certification Date: 01/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10700 CHARTER DRIVE STE 200
COLUMBIA MD
21044-3629
US

IV. Provider business mailing address

10700 CHARTER DRIVE STE 200
COLUMBIA MD
21044-3629
US

V. Phone/Fax

Practice location:
  • Phone: 410-715-0108
  • Fax: 410-995-3681
Mailing address:
  • Phone: 410-715-0108
  • Fax: 410-995-3681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: SEAN THOMAS GLOTH
Title or Position: PRESIDENT
Credential: MD
Phone: 410-715-0108