Healthcare Provider Details

I. General information

NPI: 1720113251
Provider Name (Legal Business Name): JERRY R. THOMAS II MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 10/14/2022
Certification Date: 10/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11055 LITTLE PATUXENT PKWY STE L1
COLUMBIA MD
21044-2897
US

IV. Provider business mailing address

11055 LITTLE PATUXENT PKWY STE L1
COLUMBIA MD
21044-2897
US

V. Phone/Fax

Practice location:
  • Phone: 410-740-7030
  • Fax: 410-740-7033
Mailing address:
  • Phone: 410-740-7030
  • Fax: 410-740-7033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberD0050349
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: