MEDICARE: DR. HAROLD PACKMAN D.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
1	1223P0300X	Periodontics	5163	MD

General Provider Information

NPI Number	:	1669502266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HAROLD PACKMAN D.M.D.

Provider Business Mailing Address
First Line	:	138 BLACKFOOT DR
Second Line	:
City	:	ARNOLD
State	:	MD
Zip	:	21012-2522
Country	:	US
Telephone Number	:	410-721-2477
Fax Number	:

Provider Business Practice Location Address
First Line	:	7600 RITCHIE HWY
Second Line	:
City	:	GLEN BURNIE
State	:	MD
Zip	:	21061-3718
Country	:	US
Telephone Number	:	410-761-3335
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	07/08/2007

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