Healthcare Provider Details

I. General information

NPI: 1154640423
Provider Name (Legal Business Name): REENA MARY THOMAS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2010
Last Update Date: 01/22/2021
Certification Date: 01/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 STEEPLE CHASE DR 307
PRINCE FREDERICK MD
20678-4054
US

IV. Provider business mailing address

PO BOX 2424
PRINCE FREDERICK MD
20678-2424
US

V. Phone/Fax

Practice location:
  • Phone: 443-432-3020
  • Fax: 410-486-7178
Mailing address:
  • Phone: 443-432-3020
  • Fax: 410-468-7178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberD0079447
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: