Provider Demographics
NPI:1144241068
Name:SANTHA, THIBIN D (MD)
Entity Type:Individual
Prefix:DR
First Name:THIBIN
Middle Name:D
Last Name:SANTHA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:THIBIN
Other - Middle Name:
Other - Last Name:SANTHA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 2661
Mailing Address - Street 2:
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-2661
Mailing Address - Country:US
Mailing Address - Phone:410-535-1005
Mailing Address - Fax:410-535-0707
Practice Address - Street 1:3995 OLD TOWN RD
Practice Address - Street 2:STE 203
Practice Address - City:HUNTINGTOWN
Practice Address - State:MD
Practice Address - Zip Code:20639-3039
Practice Address - Country:US
Practice Address - Phone:410-535-1005
Practice Address - Fax:410-535-0707
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0064324207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
11605412OtherCAQH