Basic Information
Provider Information
NPI: 1043274541
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LLOYD
FirstName: RALPH
MiddleName: HOWARD
NamePrefix: MR.
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 10 N GREENE ST
Address2: MEDICAL CARE CLINICAL CENTER (111)
City: BALTIMORE
State: MD
PostalCode: 212011524
CountryCode: US
TelephoneNumber: 4106057000
FaxNumber: 4106057845
Practice Location
Address1: 10 N GREENE ST
Address2: MEDICAL CARE CLINICAL CENTER (111)
City: BALTIMORE
State: MD
PostalCode: 212011524
CountryCode: US
TelephoneNumber: 4106057000
FaxNumber: 4106057845
Other Information
ProviderEnumerationDate: 04/13/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: X
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000XC0000204MDY Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

No ID Information.


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