Provider Demographics
NPI:1477670248
Name:BILGRAVE, DYER P (PHD)
Entity Type:Individual
Prefix:DR
First Name:DYER
Middle Name:P
Last Name:BILGRAVE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 NORTHWAY
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-1115
Mailing Address - Country:US
Mailing Address - Phone:443-562-8331
Mailing Address - Fax:
Practice Address - Street 1:6525 N CHARLES ST
Practice Address - Street 2:SUITE 237
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21204-6872
Practice Address - Country:US
Practice Address - Phone:443-562-8331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04014103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist