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General NPI Number Information
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NPI Number | 1679882401
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Entity Type | Organization
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Legal Business Name | TB MEDICAL LLC
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Dates
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Enumeration Date | 09/28/2010
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Last Update Date | 02/05/2020
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Provider Practice Location Address
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Address Line | 10753 FALLS RD 225
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City | LUTHERVILLE
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State | MD
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Zip | 21093-4535
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Country | US
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Telephone | 410-583-2844
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Fax | 410-583-2841
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Provider Business Mailing Address
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Address Line | 10753 FALLS RD 225
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City | LUTHERVILLE
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State | MD
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Zip | 21093-4535
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Country | US
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Telephone | 410-583-2844
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Fax | 410-583-2841
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Authorized Official
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Title or Position | ADMINISTRATOR/AUTHORIZED OFFICIAL
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Name | EVA MCCANN
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Credential |
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Telephone | 410-847-3839
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | D50592
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License Number State | MD
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