Provider Demographics
NPI:1326759606
Name:INTEGRATIVE CENTER FOR THYROID & METABOLIC DISORDERS LLC
Entity Type:Organization
Organization Name:INTEGRATIVE CENTER FOR THYROID & METABOLIC DISORDERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUBY
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:443-375-2909
Mailing Address - Street 1:830 QUIET MEADOW CT
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21158-9493
Mailing Address - Country:US
Mailing Address - Phone:443-375-2909
Mailing Address - Fax:410-861-5258
Practice Address - Street 1:1812 BALTIMORE BLVD STE C
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-7144
Practice Address - Country:US
Practice Address - Phone:410-861-5256
Practice Address - Fax:410-861-5258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-08
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty