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Individual

DR. DONNA LORRAINE TICKNOR

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
1600 CRAIN HWY S STE 608, GLEN BURNIE, MD 21061-6442
(410) 205-9205
(619) 268-5973
Mailing address
408 KATHE CT, RIVA, MD 21140-1312
(301) 996-2949
(619) 268-5973

Taxonomy

Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
D0086372
MD
2084P0800X
Psychiatry Physician
MD32440
DC

Other

Enumeration date
01/19/2007
Last updated
05/15/2024
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