Basic Information
| Provider Information | |||||||||
| NPI: | 1821264425 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WITHUHN | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | FREDERICK | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D., M.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6190 GEORGETOWN BLVD STE 104 | ||||||||
| Address2: | |||||||||
| City: | ELDERSBURG | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217846460 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105525050 | ||||||||
| FaxNumber: | 4105520200 | ||||||||
| Practice Location | |||||||||
| Address1: | 10084 REISTERSTOWN RD STE 200A | ||||||||
| Address2: | |||||||||
| City: | OWINGS MILLS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211174096 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105525050 | ||||||||
| FaxNumber: | 4105520200 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2008 | ||||||||
| LastUpdateDate: | 03/09/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | D80017 | MD | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 23614 | WV | N | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.