Individual
CAROLYN WYATT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
8808 CENTRE PARK DR, SUITE 206, COLUMBIA, MD 21045-2126
(410) 884-6116
(410) 730-1803
Mailing address
8808 CENTRE PARK DRIVE, SUITE 206, COLUMBIA, MD 21045
(410) 884-6116
(410) 730-1803
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
D0032932
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
597771103
—
MD
Enumeration date
05/16/2006
Last updated
05/25/2012
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