Healthcare Provider Details

I. General information

NPI: 1255369781
Provider Name (Legal Business Name): DAVID MICHAEL THOMAS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 12/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 INDIANA AVE
HALETHORPE MD
21227-2250
US

IV. Provider business mailing address

3020 INDIANA AVE
HALETHORPE MD
21227-2250
US

V. Phone/Fax

Practice location:
  • Phone: 703-340-8865
  • Fax:
Mailing address:
  • Phone: 703-340-8865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number30511
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: