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General NPI Number Information
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NPI Number | 1730892035
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Entity Type | Organization
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Legal Business Name | INNOVATIVE TREATMENT CENTERS
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Dates
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Enumeration Date | 01/02/2023
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Last Update Date | 05/19/2023
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Provider Practice Location Address
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Address Line | 325 HOSPITAL DR STE 106
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City | GLEN BURNIE
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State | MD
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Zip | 21061-5806
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Country | US
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Telephone | 917-873-5716
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Fax |
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Provider Business Mailing Address
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Address Line | 325 HOSPITAL DR STE 106
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City | GLEN BURNIE
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State | MD
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Zip | 21061-5806
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Country | US
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Telephone | 917-873-5716
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TRAVIS A BAIRD
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Credential | NP
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Telephone | 443-430-2998
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health 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 | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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