Healthcare Provider Details

I. General information

NPI: 1144234477
Provider Name (Legal Business Name): LARNEY R GUMP PH D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 PROGRESS WAY SUITE 101
ELDERSBURG MD
21784
US

IV. Provider business mailing address

1380 PROGRESS WAY # 101
ELDERSBURG MD
21784
US

V. Phone/Fax

Practice location:
  • Phone: 410-549-5181
  • Fax: 410-549-5182
Mailing address:
  • Phone: 410-549-5181
  • Fax: 410-549-5182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number00487
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: