=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932471570
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VERNON THOMAS SAVAGE PHD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/28/2012
-----------------------------------------------------
Last Update Date | 01/28/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20 CROSSROADS DR SUIT 104
-----------------------------------------------------
City | OWINGS MILLS
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21117-5419
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-655-0183
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9605 MENDOZA RD
-----------------------------------------------------
City | RANDALLSTOWN
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21133-2502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-655-0183
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 02490
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------