Provider Demographics
NPI:1194088955
Name:TIMOTHY P. PASSARELLO, DDS, PA
Entity type:Organization
Organization Name:TIMOTHY P. PASSARELLO, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:PASSARELLO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-549-1200
Mailing Address - Street 1:6200 GEORGETOWN BLVD
Mailing Address - Street 2:
Mailing Address - City:ELDERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21784-6410
Mailing Address - Country:US
Mailing Address - Phone:410-549-1200
Mailing Address - Fax:
Practice Address - Street 1:6200 GEORGETOWN BLVD
Practice Address - Street 2:
Practice Address - City:ELDERSBURG
Practice Address - State:MD
Practice Address - Zip Code:21784-6410
Practice Address - Country:US
Practice Address - Phone:410-549-1200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD9139261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental