Provider Demographics
NPI:1609849769
Name:TYLER, BEVERLY ANN (MD)
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:ANN
Last Name:TYLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:9649 BELAIR ROAD
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:BALTIMOR
Mailing Address - State:MD
Mailing Address - Zip Code:21236-1100
Mailing Address - Country:US
Mailing Address - Phone:410-248-2650
Mailing Address - Fax:410-248-2656
Practice Address - Street 1:104 PLUMTREE ROAD
Practice Address - Street 2:SUITE 115
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015-5901
Practice Address - Country:US
Practice Address - Phone:410-515-4300
Practice Address - Fax:410-515-4318
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2010-10-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0034255208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDB70847Medicare UPIN