Healthcare Provider Details

I. General information

NPI: 1790901619
Provider Name (Legal Business Name): JOSHUA ADAM THOMAS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 03/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 SKINNERS TURN RD
OWINGS MD
20736-3041
US

IV. Provider business mailing address

1919 SKINNERS TURN RD
OWINGS MD
20736-3041
US

V. Phone/Fax

Practice location:
  • Phone: 410-575-3429
  • Fax: 866-214-0466
Mailing address:
  • Phone: 301-485-7400
  • Fax: 866-214-0466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberOS013418
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberH69982
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: