Provider Demographics
NPI:1659977569
Name:TOBIN, JAMES
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:TOBIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11401 IAGER BLVD
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MD
Mailing Address - Zip Code:20759-2508
Mailing Address - Country:US
Mailing Address - Phone:443-414-1966
Mailing Address - Fax:
Practice Address - Street 1:11401 IAGER BLVD
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MD
Practice Address - Zip Code:20759-2508
Practice Address - Country:US
Practice Address - Phone:443-414-1966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC7418101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional