Provider Demographics
NPI:1619301439
Name:COMPREHENSIVE ALLERGY AND ASTHMA CARE CENTER, LLC
Entity Type:Organization
Organization Name:COMPREHENSIVE ALLERGY AND ASTHMA CARE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TARYN
Authorized Official - Middle Name:R
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-206-9601
Mailing Address - Street 1:12164 CENTRAL AVE
Mailing Address - Street 2:SUITE 225
Mailing Address - City:MITCHELLVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-1944
Mailing Address - Country:US
Mailing Address - Phone:240-206-9601
Mailing Address - Fax:240-206-9072
Practice Address - Street 1:12164 CENTRAL AVE
Practice Address - Street 2:SUITE 225
Practice Address - City:MITCHELLVILLE
Practice Address - State:MD
Practice Address - Zip Code:20721-1944
Practice Address - Country:US
Practice Address - Phone:240-206-9601
Practice Address - Fax:240-206-9072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-28
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0068780261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty