1144241068 NPI number — DR. THIBIN D SANTHA M.D.

Table of content: DR. THIBIN D SANTHA M.D. (NPI 1144241068)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144241068 NPI number — DR. THIBIN D SANTHA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANTHA
Provider First Name:
THIBIN
Provider Middle Name:
D
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SANTHA
Provider Other First Name:
THIBIN
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1144241068
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/16/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3995 OLD TOWN RD
Provider Second Line Business Practice Location Address:
STE 203
Provider Business Practice Location Address City Name:
HUNTINGTOWN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20639-3039
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-535-1005
Provider Business Practice Location Address Fax Number:
410-535-0707
Provider Enumeration Date:
07/23/2006

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: 207RN0300X , with the licence number:  D0064324 , 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: 11605412 . This is a "CAQH" identifier . This identifiers is of the category "OTHER".




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