Provider Demographics
NPI:1609266600
Name:LINTHICUM, AMY MARIE
Entity type:Individual
Prefix:MISS
First Name:AMY
Middle Name:MARIE
Last Name:LINTHICUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 MARTIN BLVD
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-4104
Mailing Address - Country:US
Mailing Address - Phone:410-406-9082
Mailing Address - Fax:443-868-3113
Practice Address - Street 1:1330 MARTIN BLVD
Practice Address - Street 2:
Practice Address - City:MIDDLE RIVER
Practice Address - State:MD
Practice Address - Zip Code:21220-4104
Practice Address - Country:US
Practice Address - Phone:410-406-9082
Practice Address - Fax:443-868-3113
Is Sole Proprietor?:No
Enumeration Date:2015-01-28
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDT08165247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other