MEDICARE: DR. THIBIN D SANTHA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician	D0064324	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11605412	OTHER		CAQH

General Provider Information

NPI Number	:	1144241068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THIBIN D SANTHA M.D.

Provider Business Mailing Address
First Line	:	PO BOX 2661
Second Line	:
City	:	PRINCE FREDERICK
State	:	MD
Zip	:	20678-2661
Country	:	US
Telephone Number	:	410-535-1005
Fax Number	:	410-535-0707

Provider Business Practice Location Address
First Line	:	3995 OLD TOWN RD
Second Line	:	STE 203
City	:	HUNTINGTOWN
State	:	MD
Zip	:	20639-3039
Country	:	US
Telephone Number	:	410-535-1005
Fax Number	:	410-535-0707

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/23/2006
Last Update Date	:	03/16/2017

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