Individual
TYLAR HALLMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12290 GREENMEDOW DRIVE, 117, COLUMBIA, MD 21042-1044
(301) 323-8461
Mailing address
12290 GREENMEDOW DRIVE, 117, COLUMBIA, MD 21042-1044
(301) 323-8461
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00000
CRANIAL PROSTHESIS - MEDICAL WIGS
MD
Enumeration date
03/22/2019
Last updated
06/11/2019
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