Healthcare Provider Details

I. General information

NPI: 1457348757
Provider Name (Legal Business Name): AMY ERIN MAGLADRY MED, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/02/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 COWPENS AVE
TOWSON MD
21286-1720
US

IV. Provider business mailing address

1554 DOXBURY RD
TOWSON MD
21286-5903
US

V. Phone/Fax

Practice location:
  • Phone: 410-887-3543
  • Fax:
Mailing address:
  • Phone: 410-733-0217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: