Provider Demographics
NPI:1326007568
Name:THEIN, MYA S (MD)
Entity Type:Individual
Prefix:
First Name:MYA
Middle Name:S
Last Name:THEIN
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:PO BOX 630776
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-2602
Mailing Address - Country:US
Mailing Address - Phone:410-328-7157
Mailing Address - Fax:
Practice Address - Street 1:22 S GREENE ST RM S9D10
Practice Address - Street 2:MARLENE AND STEWART GREENEBAUM CANCER CENTER
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1544
Practice Address - Country:US
Practice Address - Phone:410-328-7157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD58371207RH0003X
MDD0058371207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD786804900Medicaid
MDS053-0082OtherCAREFIRST BC/BS
MDS053-0082OtherCAREFIRST BC/BS
MD169599ZAQPMedicare PIN
MD786804900Medicaid