Provider Demographics
NPI:1023578366
Name:HALLMAN, TYLAR
Entity Type:Individual
Prefix:
First Name:TYLAR
Middle Name:
Last Name:HALLMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12290 GREENMEDOW DRIVE
Mailing Address - Street 2:117
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21042-1044
Mailing Address - Country:US
Mailing Address - Phone:301-323-8461
Mailing Address - Fax:
Practice Address - Street 1:12290 GREENMEDOW DRIVE
Practice Address - Street 2:117
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21042-1044
Practice Address - Country:US
Practice Address - Phone:301-323-8461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-22
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD00000OtherCRANIAL PROSTHESIS - MEDICAL WIGS