Basic Information
| Provider Information | |||||||||
| NPI: | 1578666715 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THOMAS | ||||||||
| FirstName: | ANNIE | ||||||||
| MiddleName: | T | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5730 EXECUTIVE DR STE 230 | ||||||||
| Address2: | |||||||||
| City: | CATONSVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212281762 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7039234644 | ||||||||
| FaxNumber: | 7039234625 | ||||||||
| Practice Location | |||||||||
| Address1: | 7440 SPRING VILLAGE DR | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | VA | ||||||||
| PostalCode: | 221504446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7039234644 | ||||||||
| FaxNumber: | 7039234625 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2006 | ||||||||
| LastUpdateDate: | 02/25/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 0101057797 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 8132487 | 01 | VA | MAMSI | OTHER | 466590 | 01 | VA | ANTHEM | OTHER | B3800008 | 01 | VA | CAREFIRST BC/BS | OTHER | 193676203 | 01 | VA | UNITED HEALTHCARE | OTHER | 5686657 | 01 | VA | AETNA | OTHER |