# WHITE MARSH HEALTHCARE PHYSICAL MEDICINE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063722700
- **Authorized official:** TIMOTHY GOBER (OWNER)
- **Authorized official phone:** (443) 600-5807

## Contact information

- **Practice address:** 5430 CAMPBELL BLVD., STE. 106, WHITE MARSH, MD 21162
- **Practice address phone:** (443) 600-5807
- **Practice address fax:** (443) 725-4933
- **Mailing address:** 5430 CAMPBELL BLVD., STE. 106, WHITE MARSH, MD 21162
- **Mailing address phone:** (443) 725-4930
- **Mailing address fax:** (443) 725-4933

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111N00000X | Chiropractor | 03470 | MD | — |
| 111N00000X | Chiropractor | 03606 | MD | — |
| 207R00000X | Internal Medicine Physician | MD20215 | MD | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |
| 208D00000X | General Practice Physician | D27411 | MD | — |
| 208VP0014X | Interventional Pain Medicine Physician | — | NULL | — |
| 208VP0014X | Interventional Pain Medicine Physician | — | — | — |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 363A00000X | Physician Assistant | C3824 | MD | — |
| 363AM0700X | Medical Physician Assistant | C0000614 | MD | — |

## Other

- **Enumeration date:** 10/15/2010
- **Last updated:** 08/10/2011