Provider Demographics
NPI:1093881781
Name:TALLER, MIKHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MIKHAEL
Middle Name:
Last Name:TALLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8620 TIMBER HILL LN
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-4239
Mailing Address - Country:US
Mailing Address - Phone:410-908-7251
Mailing Address - Fax:301-765-0396
Practice Address - Street 1:6615 REISTERSTOWN RD STE 205A
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-2690
Practice Address - Country:US
Practice Address - Phone:410-908-7251
Practice Address - Fax:301-765-0396
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00502312084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD426QMedicare ID - Type UnspecifiedPSYCHIATRY
MDTA894022Medicare ID - Type UnspecifiedPSYCHIATRY
G31263Medicare UPIN