Healthcare Provider Details

I. General information

NPI: 1326469206
Provider Name (Legal Business Name): RYNE LAXTON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2013
Last Update Date: 04/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16220 FREDERICK RD 310
GAITHERSBURG MD
20877-4039
US

IV. Provider business mailing address

16220 FREDERICK RD 310
GAITHERSBURG MD
20877-4039
US

V. Phone/Fax

Practice location:
  • Phone: 301-345-1022
  • Fax:
Mailing address:
  • Phone: 301-345-1022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number18885
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: