Healthcare Provider Details

I. General information

NPI: 1790951986
Provider Name (Legal Business Name): SUNIL THADANI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2008
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5205 CHAIRMANS CT STE 202
FREDERICK MD
21703-2918
US

IV. Provider business mailing address

5205 CHAIRMANS CT STE 202
FREDERICK MD
21703-2918
US

V. Phone/Fax

Practice location:
  • Phone: 240-575-9580
  • Fax:
Mailing address:
  • Phone: 240-575-9580
  • Fax: 240-457-4939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberD0070611
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207WX0120X
TaxonomyCornea and External Diseases Specialist Physician
License NumberD0070611
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: