Provider Demographics
NPI:1245380401
Name:THOMASKUTTY, MERCY K (MD)
Entity Type:Individual
Prefix:
First Name:MERCY
Middle Name:K
Last Name:THOMASKUTTY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17854 BOWIE MILL RD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20855-1609
Mailing Address - Country:US
Mailing Address - Phone:301-948-1515
Mailing Address - Fax:301-948-1513
Practice Address - Street 1:17854 BOWIE MILL RD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20855-1609
Practice Address - Country:US
Practice Address - Phone:301-948-1515
Practice Address - Fax:301-948-1513
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0025546207L00000X
MDDOO25546207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDB95163Medicare UPIN
MD010NJ918Medicare ID - Type Unspecified