MEDICARE: DR. TYLER RICKARDS PH.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	103G00000X	Clinical Neuropsychologist	05665	MD
2	2084B0040X	Behavioral Neurology & Neuropsychiatry Physician	05665	MD

General Provider Information

NPI Number	:	1962807867
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TYLER RICKARDS PH.D.

Provider Business Mailing Address
First Line	:	5051 GREENSPRING AVE STE 300
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21209-4358
Country	:	US
Telephone Number	:	410-601-1958
Fax Number	:	410-601-7828

Provider Business Practice Location Address
First Line	:	600 N WOLFE ST
Second Line	:	MEYER 1-163
City	:	BALTIMORE
State	:	MD
Zip	:	21287-0005
Country	:	US
Telephone Number	:	814-330-7464
Fax Number	:

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

Provider Enumeration Date	:	11/04/2014
Last Update Date	:	01/02/2024

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