Healthcare Provider Details

I. General information

NPI: 1245868165
Provider Name (Legal Business Name): THABISO MASEKO PHIRI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2020
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8501 LA SALLE RD STE 103
TOWSON MD
21286-5919
US

IV. Provider business mailing address

8501 LA SALLE RD STE 103
TOWSON MD
21286-5919
US

V. Phone/Fax

Practice location:
  • Phone: 410-532-1640
  • Fax: 410-321-5787
Mailing address:
  • Phone: 410-532-1640
  • Fax: 410-321-5787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberD0104394
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: