Provider Demographics
NPI:1376851030
Name:HUMBURG, TED STEVEN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TED
Middle Name:STEVEN
Last Name:HUMBURG
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11718 KING TREE ST
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-2637
Mailing Address - Country:US
Mailing Address - Phone:301-706-7036
Mailing Address - Fax:
Practice Address - Street 1:600 N WOLFE ST
Practice Address - Street 2:CARNEGIE 180
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-6180
Practice Address - Country:US
Practice Address - Phone:301-706-7036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-15
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19631183500000X
DCPH100000886183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist