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NPI Code Detail

MEDICARE: DR. DENNIS LYNN HEADINGS M.D.

MEDICARE: DR. DENNIS LYNN HEADINGS M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics PhysicianD0019255MD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1D0019255OTHERMDMEDICAL LICENSE
2M04262OTHERMDMARYLAND CDS LICENSE

General Provider Information

NPI Number : 1225013279
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DENNIS LYNN HEADINGS M.D.
Provider Business Mailing Address
First Line : 10807 FALLS RD
Second Line : SUITE 200
City : LUTHERVILLE
State : MD
Zip : 21093-4591
Country : US
Telephone Number : 410-321-9393
Fax Number :
Provider Business Practice Location Address
First Line : 10807 FALLS RD
Second Line : SUITE 200
City : LUTHERVILLE
State : MD
Zip : 21093-4591
Country : US
Telephone Number : 410-321-9393
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/13/2005
Last Update Date : 03/07/2023

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