MEDICARE: MR. THOMAS M TAX PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AS0400X	Surgical Physician Assistant	C00440	MD

General Provider Information

NPI Number	:	1336176478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THOMAS M TAX PA-C

Provider Business Mailing Address
First Line	:	14732 JAYSTONE DR
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20905-7410
Country	:	US
Telephone Number	:	301-879-9299
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 FOREST GLEN ROAD
Second Line	:	HOLY CROSS HOSPITAL
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-1484
Country	:	US
Telephone Number	:	301-754-7000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2006
Last Update Date	:	07/08/2007

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