1396721072 NPI number — HAROLD C THOMAS MD

Table of content: HAROLD C THOMAS MD (NPI 1396721072)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396721072 NPI number — HAROLD C THOMAS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMAS
Provider First Name:
HAROLD
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1396721072
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 JUNEBERRY CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOWIE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20721-7242
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-249-2795
Provider Business Mailing Address Fax Number:
301-249-2795

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 HOSPITAL DRVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLEN BURNIE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21061
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-787-4394
Provider Business Practice Location Address Fax Number:
410-787-4304
Provider Enumeration Date:
12/15/2005

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: 207P00000X , with the licence number:  MD17569 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0009 DC . This is a "BLUECROSS BLUESHIELD" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 60238401 . This is a "BLUE SHIELD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: J8740001 . This is a "FEDERAL EMPLOYEE PROGRAM" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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