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General NPI Number Information
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NPI Number | 1043884554
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Entity Type | Individual
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Provider Name | THOMAS J CONWAY ADT
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Gender | Male
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Dates
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Enumeration Date | 05/19/2021
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Last Update Date | 05/19/2021
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Provider Practice Location Address
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Address Line | 112 E PATAPSCO AVE
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City | BALTIMORE
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State | MD
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Zip | 21225-1745
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Country | US
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Telephone | 667-260-2640
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Fax |
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Provider Business Mailing Address
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Address Line | 1115 LEONARD DR
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City | GLEN BURNIE
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State | MD
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Zip | 21060-8236
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Country | US
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Telephone | 443-875-1718
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 1712
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License Number State | MD
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