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DR. JOHN ROBERT TICEHURST M.D.

Physicians Pathology Clinical Pathology/Laboratory Medicine

Provider NPI: 1962558437

Provider Information:
DR. JOHN ROBERT TICEHURST M.D.
Gender: M
Not Sole Proprietor

Practice Location:
7385 BALTIMORE ANNAPOLIS BLVD STE L  GLEN BURNIE, MD 21061-3278 US
Tel: 410-999-6421  Fax: --

Business Mailing Address:
4940 EASTERN AVE CLINICAL LABS, ROOM A102, JOHNS HOPKINS BAYVIEW MED CTR BALTIMORE, MD 21224-2735 US
Tel: (41-0) -550-0648  Fax: 410-550-2109

NPI Information:
NPI: 1962558437
Entity Type: Individual

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y207ZP0105XPhysicians
Pathology
Clinical Pathology/Laboratory Medicine
MDD0050680

Other Provider Identifiers:

IssuerNumberStateType



American Medical Association 2012 taxonomy code information

Code: 207ZP0105X

Type:

Classification:



Definition:



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