| Boonyong P Thada, M.d., P.a. | |
|
5356 Reisterstown Rd Baltimore MD 21215-4426 | |
| (410) 358-5111 | |
| (410) 358-9169 |
| Full Name | Boonyong P Thada, M.d., P.a. |
|---|---|
| Speciality | Internal Medicine |
| Location | 5356 Reisterstown Rd, Baltimore, Maryland |
| Authorized Official Name and Position | Boonyong P Thada (PHYSICIAN) |
| Authorized Official Contact | 4103585111 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Boonyong P Thada, M.d., P.a. 5356 Reisterstown Rd Baltimore MD 21215-4426 Ph: (410) 358-5111 | Boonyong P Thada, M.d., P.a. 5356 Reisterstown Rd Baltimore MD 21215-4426 Ph: (410) 358-5111 |
| NPI Number | 1194035097 |
|---|---|
| Provider Enumeration Date | 10/14/2010 |
| Last Update Date | 10/19/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194035097 | NPI | - | NPPES |
| 220561100 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | D0019823 (Maryland) | Primary |
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