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NPI Code Detail

MEDICARE: THOMAS HUGH HAVENS PA-C

MEDICARE: THOMAS HUGH HAVENS PA-C
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
1363AS0400XSurgical Physician Assistant
2207P00000XEmergency Medicine PhysicianC0008823MD

General Provider Information

NPI Number : 1346995826
Entity Type Code : Individual
Provider Name (Legal Business Name) : THOMAS HUGH HAVENS PA-C
Provider Business Mailing Address
First Line : 1901 MCGUCKIAN AVE UNIT 315
Second Line :
City : ANNAPOLIS
State : MD
Zip : 21401-4047
Country : US
Telephone Number : 703-509-6477
Fax Number :
Provider Business Practice Location Address
First Line : 8118 GOOD LUCK RD
Second Line :
City : LANHAM
State : MD
Zip : 20706-3574
Country : US
Telephone Number : 703-509-6477
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/14/2022
Last Update Date : 03/08/2026

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