Basic Information
| Provider Information | |||||||||
| NPI: | 1578704813 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THIBIN SANTHA MD, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2661 | ||||||||
| Address2: | |||||||||
| City: | PRINCE FREDERICK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 206782661 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103266978 | ||||||||
| FaxNumber: | 4103942805 | ||||||||
| Practice Location | |||||||||
| Address1: | 14090 HG TRUEMAN ROAD | ||||||||
| Address2: | SUITE 1300, BOX 93 | ||||||||
| City: | SOLOMONS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 206883151 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103266978 | ||||||||
| FaxNumber: | 4103942805 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2009 | ||||||||
| LastUpdateDate: | 10/29/2009 | ||||||||
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| AuthorizedOfficialLastName: | SANTHA | ||||||||
| AuthorizedOfficialFirstName: | THIBIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4103266978 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | D0064324 | MD | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
No ID Information.