Basic Information
| Provider Information | |||||||||
| NPI: | 1366705667 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CUDJOE | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | KOFI MENSAH | ||||||||
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| Credential: | MD, MPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | DIVISION OF GERIATRIC MEDICINE AND GERONTOLOGY | ||||||||
| Address2: | MASON F. LORD BUILDING, 2ND FLOOR, SUITE 2200 | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105507162 | ||||||||
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| Practice Location | |||||||||
| Address1: | DIVISION OF GERIATRIC MEDICINE AND GERONTOLOGY | ||||||||
| Address2: | MASON F. LORD BUILDING, 2ND FLOOR, SUITE 2200 | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105507162 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2012 | ||||||||
| LastUpdateDate: | 03/04/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | D0082010 | MD | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RG0300X | D0082010 | MD | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
No ID Information.