Donna Lorraine Ticknor, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

D0086372 Issued in MD

Practice address

1600 Crain Hwy S Ste 608
Glen Burnie, MD 21061-6442

Phone

(410) 205-9205

Fax

(619) 268-5973

NPI assigned

Jan 19, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jan 9, 2019 through Jan 9, 2027

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• South River Psychiatric Services, LLC

  • Psychiatry Physician
  • Glen Burnie, MD
  • NPI 1275382871
  NPD Authorized official

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

{
    "created_epoch": "1169164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715731200000",
    "number": "1720131295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "408 KATHE CT",
            "city": "RIVA",
            "state": "MD",
            "postal_code": "211401312",
            "telephone_number": "301-996-2949",
            "fax_number": "619-268-5973"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 CRAIN HWY S STE 608",
            "city": "GLEN BURNIE",
            "state": "MD",
            "postal_code": "210616442",
            "telephone_number": "410-205-9205",
            "fax_number": "619-268-5973"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "877 Baltimore Annapolis Blvd Ste 202",
            "address_purpose": "LOCATION",
            "city": "Severna Park",
            "state": "MD",
            "postal_code": "211464716",
            "country_code": "US",
            "telephone_number": "410-684-3806",
            "fax_number": "410-421-8042",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TICKNOR",
        "first_name": "DONNA",
        "middle_name": "LORRAINE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-19",
        "last_updated": "2024-05-15",
        "certification_date": "2024-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "DC",
            "license": "MD32440",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MD",
            "license": "D0086372",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sara Shanika Thompson
• Thomas Thompson IV, LMSW
• Rachel Lynn Throndset, MSN, FNP-C
• Through the Embers
• John Robert Ticehurst, M.D.
• Tidewater LLC
• Shannon Liedquist Tieman, CRNP
• Kaitlin Tierney, PT, DPT
• Idaat Bisola Timbo-Jalloh
• Time Organization

• Psychiatry Physician in Glen Burnie, MD
• Providers in Glen Burnie, MD by specialty
• Psychiatry Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.