Provider Demographics
NPI:1003888322
Name:TOTAL IMAGE CARE, INC
Entity Type:Organization
Organization Name:TOTAL IMAGE CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:410-560-0614
Mailing Address - Street 1:800 ARMY RD
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-6701
Mailing Address - Country:US
Mailing Address - Phone:410-560-0614
Mailing Address - Fax:410-560-0613
Practice Address - Street 1:9103 FRANKLIN SQUARE DR
Practice Address - Street 2:SUITE 1700
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237-3900
Practice Address - Country:US
Practice Address - Phone:443-777-6302
Practice Address - Fax:443-777-6309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-02
Last Update Date:2010-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDMH24OtherCAREFIRST BLUE CROSS BLUE SHIELD
DCF807OtherCAREFIRST BLUE CROSS BLUE SHIELD
MD601000800Medicaid
1146880002Medicare NSC