Healthcare Provider Details

I. General information

NPI: 1679544175
Provider Name (Legal Business Name): JOSEPH THOMAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9811 MALLARD DR SUITE NO.114
LAUREL MD
20708-3143
US

IV. Provider business mailing address

9811 MALLARD DR SUITE NO.114
LAUREL MD
20708-3143
US

V. Phone/Fax

Practice location:
  • Phone: 301-776-1636
  • Fax: 301-776-7030
Mailing address:
  • Phone: 301-776-1636
  • Fax: 301-776-7030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberD0019386
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: