Provider Demographics
NPI:1326211806
Name:MERCY THOMASKUTTY M.D. CHARTERED
Entity Type:Organization
Organization Name:MERCY THOMASKUTTY M.D. CHARTERED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MERCY
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMASKUTTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-948-1515
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-07
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD002546207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD08286MK05OtherMARYLAND BLUESHIELD
MD7678OtherD.C.BLUECROSS BLUESHIELD
MD010NMedicare PIN