NPIMap

Organization Active NPI

White Marsh Healthcare Physical Medicine,LLC

  • Clinical Medical Laboratory
  • White Marsh, MD
National Provider Identifier
1376990200
Registry record updated May 20, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
WHITE MARSH HEALTHCARE PHYSICAL MEDICINE,LLC
Practice address
5430 Campbell Blvd
Suite 106
White Marsh, MD 21162-5500
Phone
(443) 725-4930
Fax
(410) 657-7478
NPI assigned
May 20, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 20, 2016

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

Authorized official

Name
Timothy Gober
Title
Owner/Provider
Phone
(443) 725-4930

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X Primary

Addresses

Primary practice location

5430 Campbell Blvd
Suite 106
White Marsh, MD 21162-5500

Mailing address

5430 Campbell Blvd
Suite 106
White Marsh, MD 21162-5500
Phone (443) 725-4930

National Provider Directory

National Provider Directory
Tax ID family
Baltimore Pain Relief Center5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1463702400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1463702400000",
    "number": "1376990200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5430 CAMPBELL BLVD",
            "address_2": "SUITE 106",
            "city": "WHITE MARSH",
            "state": "MD",
            "postal_code": "211625500",
            "telephone_number": "443-725-4930",
            "fax_number": "410-657-7478"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5430 CAMPBELL BLVD",
            "address_2": "SUITE 106",
            "city": "WHITE MARSH",
            "state": "MD",
            "postal_code": "211625500",
            "telephone_number": "443-725-4930",
            "fax_number": "410-657-7478"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WHITE MARSH HEALTHCARE PHYSICAL MEDICINE,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-20",
        "last_updated": "2016-05-20",
        "status": "A",
        "authorized_official_last_name": "GOBER",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_title_or_position": "OWNER/PROVIDER",
        "authorized_official_telephone_number": "443-725-4930"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in White Marsh, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2016; 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.