Healthcare Provider Details

I. General information

NPI: 1821355199
Provider Name (Legal Business Name): THOMAS M HERNDON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2012
Last Update Date: 07/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8600 OLD GEORGETOWN RD MEDICAL STAFF SERVICES
BETHESDA MD
20814-1422
US

IV. Provider business mailing address

PO BOX 29348
WASHINGTON DC
20017-0348
US

V. Phone/Fax

Practice location:
  • Phone: 301-896-3100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0054030
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberD54030
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: