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Organization

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

Active
Parent organization
BOONYONG P THADA, M.D., P.A.
Organization subpart
Yes

Provider details

NPI number
Legal business name
BOONYONG P THADA, M.D., P.A.
Authorized official
DR. BOONYONG P THADA M.D. (PHYSICIAN)
(410) 358-5111
Entity
Organization

Contact information

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

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
D0019823
MD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
220561100
MD
Enumeration date
10/14/2010
Last updated
10/19/2010
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