Provider Demographics
NPI:1225874910
Name:TYRRELL, CAROLINE G
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:G
Last Name:TYRRELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3527 HUNTLEY DR
Mailing Address - Street 2:
Mailing Address - City:DAVIDSONVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21035-2440
Mailing Address - Country:US
Mailing Address - Phone:443-995-5418
Mailing Address - Fax:
Practice Address - Street 1:2410 EVERGREEN RD STE 100
Practice Address - Street 2:
Practice Address - City:GAMBRILLS
Practice Address - State:MD
Practice Address - Zip Code:21054-1979
Practice Address - Country:US
Practice Address - Phone:410-451-8140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program