Healthcare Provider Details

I. General information

NPI: 1609799196
Provider Name (Legal Business Name): DARRYL WHITEHEAD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2026
Last Update Date: 08/01/2026
Certification Date: 08/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10127 CAMPBELL BLVD
MIDDLE RIVER MD
21220-1855
US

IV. Provider business mailing address

10127 CAMPBELL BLVD
MIDDLE RIVER MD
21220-1855
US

V. Phone/Fax

Practice location:
  • Phone: 410-918-7478
  • Fax:
Mailing address:
  • Phone: 410-918-7478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberMD-10272549025
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: