Healthcare Provider Details

I. General information

NPI: 1194786996
Provider Name (Legal Business Name): JACOB TENDLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 SHADED GLEN CT
OWINGS MILLS MD
21117-3048
US

IV. Provider business mailing address

11 SHADED GLEN CT
OWINGS MILLS MD
21117-3048
US

V. Phone/Fax

Practice location:
  • Phone: 443-831-3500
  • Fax:
Mailing address:
  • Phone: 443-831-3500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License NumberD24868
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: