Individual
JOHN W DISTLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
844 WASHINGTON ROAD, SUITE 201, WESTMINSTER, MD 21157-3035
(410) 857-7900
(410) 857-1150
Mailing address
2800 QUARRY LAKE DRIVE, 100, BALTIMORE, MD 21209-3770
(410) 486-2000
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R147365
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
097702100
—
MD
Enumeration date
05/04/2006
Last updated
05/30/2012
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