John Robert Ticehurst, M.D.

Primary specialty

Clinical Pathology/Laboratory Medicine PhysicianTaxonomy code 207ZP0105X

License

D0050680 Issued in MD

Practice address

7385 Baltimore Annapolis Blvd Ste L
Glen Burnie, MD 21061-3278

Phone

(410) 999-6421

NPI assigned

Jan 26, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1169769600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1962558437",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4940 EASTERN AVE",
            "address_2": "CLINICAL LABS, ROOM A102, JOHNS HOPKINS BAYVIEW MED CTR",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212242735",
            "telephone_number": "410-550-0648",
            "fax_number": "410-550-2109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7385 BALTIMORE ANNAPOLIS BLVD STE L",
            "city": "GLEN BURNIE",
            "state": "MD",
            "postal_code": "210613278",
            "telephone_number": "410-999-6421"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TICEHURST",
        "first_name": "JOHN",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-26",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0105X",
            "taxonomy_group": "",
            "desc": "Pathology, Clinical Pathology/Laboratory Medicine",
            "state": "MD",
            "license": "D0050680",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Pathology/Laboratory Medicine Physician in Glen Burnie, MD
• Providers in Glen Burnie, MD by specialty
• Clinical Pathology/Laboratory Medicine Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.