Provider Demographics
NPI:1487659892
Name:TYZACK, JOANNA B (MD)
Entity type:Individual
Prefix:DR
First Name:JOANNA
Middle Name:B
Last Name:TYZACK
Suffix:
Gender:
Credentials:MD
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Mailing Address - Street 1:1 TEXAS STATION CT
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-8286
Mailing Address - Country:US
Mailing Address - Phone:410-828-7417
Mailing Address - Fax:410-828-4695
Practice Address - Street 1:1 TEXAS STATION CT
Practice Address - Street 2:SUITE 300
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-8286
Practice Address - Country:US
Practice Address - Phone:410-828-7417
Practice Address - Fax:410-828-4695
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD42383207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD203561600Medicaid
MDF51506Medicare UPIN
MD203561600Medicaid