Healthcare Provider Details

I. General information

NPI: 1114761624
Provider Name (Legal Business Name): TIMOTHY WILLIAM PARKER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2024
Last Update Date: 06/20/2024
Certification Date: 06/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7220 DISCOVERY DR
ELKRIDGE MD
21075-7414
US

IV. Provider business mailing address

7220 DISCOVERY DR
ELKRIDGE MD
21075-7414
US

V. Phone/Fax

Practice location:
  • Phone: 240-915-5500
  • Fax:
Mailing address:
  • Phone: 240-915-5500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR247318
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: