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General NPI Number Information
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NPI Number | 1326759606
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE CENTER FOR THYROID & METABOLIC DISORDERS LLC
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Dates
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Enumeration Date | 12/08/2022
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Last Update Date | 01/27/2023
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Provider Practice Location Address
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Address Line | 1812 BALTIMORE BLVD STE C
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City | WESTMINSTER
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State | MD
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Zip | 21157-7144
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Country | US
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Telephone | 410-861-5256
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Fax | 410-861-5258
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Provider Business Mailing Address
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Address Line | 830 QUIET MEADOW CT
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City | WESTMINSTER
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State | MD
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Zip | 21158-9493
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Country | US
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Telephone | 443-375-2909
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Fax | 410-861-5258
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Authorized Official
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Title or Position | OWNER
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Name | DR. LAURA RUBY
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Credential | CRNP
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Telephone | 443-375-2909
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number |
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License Number State |
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