Healthcare Provider Details

I. General information

NPI: 1154220234
Provider Name (Legal Business Name): MR. THOMAS NORTHRUP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2026
Last Update Date: 11/04/2026
Certification Date: 11/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9301 ANNAPOLIS RD
LANHAM MD
20706-3115
US

IV. Provider business mailing address

1128 LINDEN AVE
TAKOMA PARK MD
20912-6515
US

V. Phone/Fax

Practice location:
  • Phone: 240-296-6353
  • Fax:
Mailing address:
  • Phone: 124-029-6610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number35317
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: