Provider Demographics
NPI:1437803988
Name:TYSON, RICKIARA (CPT)
Entity Type:Individual
Prefix:MS
First Name:RICKIARA
Middle Name:
Last Name:TYSON
Suffix:
Gender:F
Credentials:CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3305 THE ALAMEDA
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-3008
Mailing Address - Country:US
Mailing Address - Phone:443-531-0226
Mailing Address - Fax:
Practice Address - Street 1:5602 BALTIMORE NATIONAL PIKE STE 302
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21228-1410
Practice Address - Country:US
Practice Address - Phone:443-531-0226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty