Basic Information
| Provider Information | |||||||||
| NPI: | 1629416672 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TASSEY | ||||||||
| FirstName: | THERESA | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 110 S PACA ST FL 6 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212011645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6672142054 | ||||||||
| FaxNumber: | 4102446080 | ||||||||
| Practice Location | |||||||||
| Address1: | 301 SAINT PAUL ST | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103329477 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2013 | ||||||||
| LastUpdateDate: | 07/10/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207P00000X | D0081082 | MD | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.