Healthcare Provider Details

I. General information

NPI: 1326759606
Provider Name (Legal Business Name): INTEGRATIVE CENTER FOR THYROID & METABOLIC DISORDERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2022
Last Update Date: 01/27/2023
Certification Date: 01/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1812 BALTIMORE BLVD STE C
WESTMINSTER MD
21157-7144
US

IV. Provider business mailing address

830 QUIET MEADOW CT
WESTMINSTER MD
21158-9493
US

V. Phone/Fax

Practice location:
  • Phone: 410-861-5256
  • Fax: 410-861-5258
Mailing address:
  • Phone: 443-375-2909
  • Fax: 410-861-5258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. LAURA RUBY
Title or Position: OWNER
Credential: CRNP
Phone: 443-375-2909