=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043880701
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRANSCENDENT PSYCHIATRY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/25/2021
-----------------------------------------------------
Last Update Date | 06/25/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 405 ALLEGHENY AVE
-----------------------------------------------------
City | TOWSON
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21204-4256
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-873-7191
-----------------------------------------------------
Fax | 410-701-2200
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6028 PINEHURST RD
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21212-2921
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-594-5763
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHIATRIST
-----------------------------------------------------
Name | CHRISTINE TRAN-BOYNES
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 410-873-7191
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------