# BOONYONG P THADA, M.D., P.A.

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** BOONYONG P THADA, M.D., P.A.
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1194035097
- **Legal business name:** BOONYONG P THADA, M.D., P.A.
- **Authorized official:** DR. BOONYONG P THADA M.D. (PHYSICIAN)
- **Authorized official phone:** (410) 358-5111

## Contact information

- **Practice address:** 5356 REISTERSTOWN RD, BALTIMORE, MD 21215-4426
- **Practice address phone:** (410) 358-5111
- **Practice address fax:** (410) 358-9169
- **Mailing address:** 5356 REISTERSTOWN RD, BALTIMORE, MD 21215-4426
- **Mailing address phone:** (410) 358-5111
- **Mailing address fax:** (410) 358-9169

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | D0019823 | MD | Yes |

## Other

- **Enumeration date:** 10/14/2010
- **Last updated:** 10/19/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 220561100 | — | MD |