Provider Demographics
NPI:1154132876
Name:MINDBRIDGE PSYCHIATRY
Entity type:Organization
Organization Name:MINDBRIDGE PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:EMLYN
Authorized Official - Last Name:THATCHER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:443-930-0785
Mailing Address - Street 1:4624 RIDDLE DR
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21236-5703
Mailing Address - Country:US
Mailing Address - Phone:443-930-0785
Mailing Address - Fax:
Practice Address - Street 1:4624 RIDDLE DR
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21236-5703
Practice Address - Country:US
Practice Address - Phone:443-930-0785
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty