Provider Demographics
NPI:1437209202
Name:GIGLIOTTI, TYME MICHAEL (LAC)
Entity Type:Individual
Prefix:MR
First Name:TYME
Middle Name:MICHAEL
Last Name:GIGLIOTTI
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2985 NORMANDY DR
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-3345
Mailing Address - Country:US
Mailing Address - Phone:410-465-5875
Mailing Address - Fax:410-684-3940
Practice Address - Street 1:107 E MAPLE RD
Practice Address - Street 2:
Practice Address - City:LINTHICUM
Practice Address - State:MD
Practice Address - Zip Code:21090-2513
Practice Address - Country:US
Practice Address - Phone:410-850-4300
Practice Address - Fax:410-684-3940
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU00742171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist