Provider Demographics
NPI:1023317518
Name:RUNKO, VIRGINIA TAI (PHD)
Entity type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:TAI
Last Name:RUNKO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MS
Other - First Name:VIRGINIA
Other - Middle Name:TAI
Other - Last Name:CORYELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:6535 N CHARLES ST
Mailing Address - Street 2:SUITE 550
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-5826
Mailing Address - Country:US
Mailing Address - Phone:410-494-1662
Mailing Address - Fax:
Practice Address - Street 1:6535 N CHARLES ST
Practice Address - Street 2:SUITE 550
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-5826
Practice Address - Country:US
Practice Address - Phone:410-494-1662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-23
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05054103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical