White Marsh Healthcare Physical Medicine LLC

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

Legal business name

WHITE MARSH HEALTHCARE PHYSICAL MEDICINE LLC

Practice address

5430 Campbell Blvd.
Ste. 106
White Marsh, MD 21162

Phone

(443) 600-5807

Fax

(443) 725-4933

NPI assigned

Oct 15, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Timothy Gober

Title

Owner

Phone

(443) 600-5807

Specialties & licenses 9

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1287100800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1312934400000",
    "number": "1063722700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5430 CAMPBELL BLVD.",
            "address_2": "STE. 106",
            "city": "WHITE MARSH",
            "state": "MD",
            "postal_code": "21162",
            "telephone_number": "443-725-4930",
            "fax_number": "443-725-4933"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5430 CAMPBELL BLVD.",
            "address_2": "STE. 106",
            "city": "WHITE MARSH",
            "state": "MD",
            "postal_code": "21162",
            "telephone_number": "443-600-5807",
            "fax_number": "443-725-4933"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WHITE MARSH HEALTHCARE PHYSICAL MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-15",
        "last_updated": "2011-08-10",
        "status": "A",
        "authorized_official_last_name": "GOBER",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "443-600-5807"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "MD",
            "license": "03606",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "MD",
            "license": "03470",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "MD",
            "license": "MD20215",
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "MD",
            "license": "D27411",
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": "MD",
            "license": "C3824",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant, Medical",
            "state": "MD",
            "license": "C0000614",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chinyere Delicia Umezurike, CRNP
• Amber Giesel Viel, NURSE PRACTITIONER
• Watermark Health Services LLC
• Wellness Infusions
• White Marsh Healthcare & Physical Medicine,LLC (Baltimore Pain Relief Center)
• White Marsh Healthcare Physical Medicine,LLC
• White Marsh Pediatric Dentistry, LLC
• Michael Patrick Wood, LCPC
• Mark Allen Young, MD,MBA,FACP

• Physical Medicine & Rehabilitation Physician in White Marsh, MD
• Providers in White Marsh, MD by specialty
• Physical Medicine & Rehabilitation Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.