Healthcare Provider Details

I. General information

NPI: 1558337618
Provider Name (Legal Business Name): DR. RADCLIFFE THOMAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 04/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 W NORTHERN PKWY
BALTIMORE MD
21215-4473
US

IV. Provider business mailing address

7101 CARLISLE CT
CLARKSVILLE MD
21029-1739
US

V. Phone/Fax

Practice location:
  • Phone: 410-542-7700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberD42683
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: