Healthcare Provider Details

I. General information

NPI: 1336002765
Provider Name (Legal Business Name): PHLEBOTOMIST ON CALL THEBLOODLINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 YORK RD STE 800
LUTHERVILLE TIMONIUM MD
21093-6011
US

IV. Provider business mailing address

1301 YORK RD STE 800
LUTHERVILLE TIMONIUM MD
21093-6011
US

V. Phone/Fax

Practice location:
  • Phone: 410-940-2221
  • Fax: 208-608-5063
Mailing address:
  • Phone: 410-940-2221
  • Fax: 208-608-5063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2472R0900X
TaxonomyRenal Dialysis Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State

VIII. Authorized Official

Name: BERNETHA ANN MCGREW
Title or Position: CEO
Credential: PHLEBOTOMYTECHNICIAN
Phone: 410-940-2221