Healthcare Provider Details

I. General information

NPI: 1639108145
Provider Name (Legal Business Name): TOMAS H. AYALA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 01/16/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 ST PAUL PLACE BURK BLDG STE 310
BALTIMORE MD
21202
US

IV. Provider business mailing address

301 ST PAUL PLACE BURK BLDG STE 310
BALTIMORE MD
21202
US

V. Phone/Fax

Practice location:
  • Phone: 410-332-9752
  • Fax: 410-332-0626
Mailing address:
  • Phone: 410-332-9752
  • Fax: 410-332-0626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberD0058914
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: