Organization
TOTAL IMAGE CARE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EDWARD J KELLY III (CEO)
(410) 560-0614
Entity
Organization
Contact information
Practice address
9103 FRANKLIN SQUARE DR, SUITE 1700, BALTIMORE, MD 21237-3900
(443) 777-6302
(443) 777-6309
Mailing address
800 ARMY RD, TOWSON, MD 21204-6701
(410) 560-0614
(410) 560-0613
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
601000800
—
MD
01
—
F807
CAREFIRST BLUE CROSS BLUE SHIELD
DC
01
—
MH24
CAREFIRST BLUE CROSS BLUE SHIELD
MD
Enumeration date
02/02/2006
Last updated
04/02/2010
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