Healthcare Provider Details

I. General information

NPI: 1649961137
Provider Name (Legal Business Name): MR. MICHAEL MORGAN III
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2023
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WASHINGTON AVE FL 5
TOWSON MD
21204-4763
US

IV. Provider business mailing address

1016 PALMER RD APT 12
FORT WASHINGTON MD
20744-4686
US

V. Phone/Fax

Practice location:
  • Phone: 240-668-4415
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: