1649229519 NPI number — DR. THOMAS A BIONDO M.D.

Table of content: DR. THOMAS A BIONDO M.D. (NPI 1649229519)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649229519 NPI number — DR. THOMAS A BIONDO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BIONDO
Provider First Name:
THOMAS
Provider Middle Name:
A
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:
1649229519
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/13/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
251 LEWIS LANE
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
HAVRE DE GRACE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21078-3753
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-939-4477
Provider Business Mailing Address Fax Number:
410-939-1153

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
251 LEWIS LANE
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
HAVRE DE GRACE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21078-3753
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-939-4477
Provider Business Practice Location Address Fax Number:
410-939-1153
Provider Enumeration Date:
05/09/2006

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: 207R00000X , with the licence number:  D0042800 , 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: 145388000 . This is a "WCDL" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 52483401 . This is a "BS OF MARYLAND" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: W724001 . This is a "DELMARVA HEALTH PLAN" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 348561700 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: W724001 . This is a "BS OF DC" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 000424675 . This is a "BS OF PA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 20225000000 . This is a "PHN" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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