1164415352 NPI number — DR. THOMAS K GALVIN III M.D.

Table of content: DR. THOMAS K GALVIN III M.D. (NPI 1164415352)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164415352 NPI number — DR. THOMAS K GALVIN III M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GALVIN III
Provider First Name:
THOMAS
Provider Middle Name:
K
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164415352
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/12/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
826 WASHINGTON RD STE 120
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESTMINSTER
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21157-5779
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-848-2444
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
826 WASHINGTON RD STE 120
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WESTMINSTER
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21157-5779
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-848-2444
Provider Business Practice Location Address Fax Number:
410-857-1634
Provider Enumeration Date:
08/24/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  D31660 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 110202167 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 522117444 21157 A001 . This is a "TRICARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: KH04CA . This is a "BC/BS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 35438803 . This is a "BC/BS RENDERING" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 522117444 . This is a "CIGNA HEALTHCARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 522117444 . This is a "AETNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 744400100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 861917 . This is a "MAMSI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 403281100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 625098 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 801369 . This is a "JOHNS HOPKINS HEALTHCARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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