Active NPI
Michael Bombardier, PHD
- Clinical Psychologist
- Baltimore, MD
National Provider Identifier
1013346667
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 05349
- Practice address
- 660 Kenilworth Dr
Suite 101
Baltimore, MD 21204-2313 - Phone
- (410) 583-5377
- NPI assigned
- Nov 4, 2013
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 05349 | MD | Primary |
Addresses
Primary practice location
660 Kenilworth Dr
Suite 101
Baltimore, MD 21204-2313
Mailing address
660 Kenilworth Dr
Suite 101
Towson, MD 21204-2313
Phone (512) 694-0215
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 05349 | MD | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1383523200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1429660800000",
"number": "1013346667",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "660 KENILWORTH DR",
"address_2": "SUITE 101",
"city": "TOWSON",
"state": "MD",
"postal_code": "212042313",
"telephone_number": "512-694-0215"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "660 KENILWORTH DR",
"address_2": "SUITE 101",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212042313",
"telephone_number": "410-583-5377"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOMBARDIER",
"first_name": "MICHAEL",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-11-04",
"last_updated": "2015-04-22",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MD",
"license": "05349",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Baltimore, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.