Individual
TARA MARCELL PETTIFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3530 E NORTHERN PKWY, BALTIMORE, MD 21206-1632
(443) 858-7705
Mailing address
3530 E NORTHERN PKWY, BALTIMORE, MD 21206-1632
(443) 858-7705
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
09/14/2020
Last updated
09/14/2020
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