Healthcare Provider Details

I. General information

NPI: 1225275456
Provider Name (Legal Business Name): THOMAS BRUCE NUTMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2009
Last Update Date: 01/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 CENTER DR BLDG 4 - ROOM B1-03
BETHESDA MD
20892-0425
US

IV. Provider business mailing address

4 CENTER DR BLDG 4 - ROOM B1-03
BETHESDA MD
20892-0425
US

V. Phone/Fax

Practice location:
  • Phone: 301-496-5398
  • Fax: 301-480-3757
Mailing address:
  • Phone: 301-496-5398
  • Fax: 301-480-3757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberD29940
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License NumberD29940
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: