Healthcare Provider Details

I. General information

NPI: 1902312135
Provider Name (Legal Business Name): ANDRIS LYANN DOMINICCI TORRES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2017
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 N CHARLES ST
TOWSON MD
21204-6819
US

IV. Provider business mailing address

849 FAIRMOUNT AVE FL 5
TOWSON MD
21286-2624
US

V. Phone/Fax

Practice location:
  • Phone: 410-938-5000
  • Fax:
Mailing address:
  • Phone: 443-377-5273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD0101120
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: