Healthcare Provider Details

I. General information

NPI: 1992609713
Provider Name (Legal Business Name): TARA TODD SUPPORT BROKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8081 GREEN ORCHARD RD APT T3
GLEN BURNIE MD
21061-5150
US

IV. Provider business mailing address

8081 GREEN ORCHARD RD APT T3
GLEN BURNIE MD
21061-5150
US

V. Phone/Fax

Practice location:
  • Phone: 410-424-8147
  • Fax:
Mailing address:
  • Phone: 410-424-8147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: