Healthcare Provider Details

I. General information

NPI: 1790700300
Provider Name (Legal Business Name): HUMANIM INPATIENT AND OUTPATIENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 07/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5755 CEDAR LN
COLUMBIA MD
21044-2912
US

IV. Provider business mailing address

6355 WOODSIDE CT
COLUMBIA MD
21046-1071
US

V. Phone/Fax

Practice location:
  • Phone: 410-381-7171
  • Fax: 410-381-5137
Mailing address:
  • Phone: 410-381-7171
  • Fax: 410-381-5137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number
License Number State

VIII. Authorized Official

Name: GALE BRITTON
Title or Position: DIR OF BILLING
Credential:
Phone: 410-381-7171