Healthcare Provider Details

I. General information

NPI: 1386803948
Provider Name (Legal Business Name): RAIMIE ANGELA RHODA RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2008
Last Update Date: 06/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

658 KENILWORTH DR
TOWSON MD
21204-2312
US

IV. Provider business mailing address

6824 BOSTON AVE
BALTIMORE MD
21222-1009
US

V. Phone/Fax

Practice location:
  • Phone: 410-296-9600
  • Fax:
Mailing address:
  • Phone: 410-633-2643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License NumberL0004099
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: