Provider Demographics
NPI:1154640423
Name:THOMAS, REENA MARY (MD)
Entity Type:Individual
Prefix:DR
First Name:REENA
Middle Name:MARY
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2424
Mailing Address - Street 2:
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-2424
Mailing Address - Country:US
Mailing Address - Phone:443-432-3020
Mailing Address - Fax:410-468-7178
Practice Address - Street 1:205 STEEPLE CHASE DR 307
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-4054
Practice Address - Country:US
Practice Address - Phone:443-432-3020
Practice Address - Fax:410-486-7178
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-25
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0079447207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD5810230P0000Medicaid