1265651848 NPI number — MYO THANT M.D., P.A.

Table of content: (NPI 1265651848)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265651848 NPI number — MYO THANT M.D., P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MYO THANT M.D., P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PET IMAGING CENTER AT HARFORD COUNTY
Provider Other Organization Name Type Code:
3
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:
1265651848
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9114 PHILADELPHIA RD
Provider Second Line Business Mailing Address:
SUITE 208
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21237-4317
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-687-5300
Provider Business Mailing Address Fax Number:
410-682-4418

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
602 S ATWOOD RD
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
BEL AIR
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21014-4172
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-836-7119
Provider Business Practice Location Address Fax Number:
410-836-8179
Provider Enumeration Date:
04/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
THANT
Authorized Official First Name:
MYO
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
410-836-7119

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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