Provider Demographics
NPI:1336112622
Name:DAY, THOMAS BAKER (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:BAKER
Last Name:DAY
Suffix:
Gender:M
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 47756
Mailing Address - Street 2:
Mailing Address - City:WINDSOR MILL
Mailing Address - State:MD
Mailing Address - Zip Code:21244-0756
Mailing Address - Country:US
Mailing Address - Phone:410-747-4711
Mailing Address - Fax:410-747-4766
Practice Address - Street 1:7001 JOHNNYCAKE RD STE 104
Practice Address - Street 2:
Practice Address - City:WINDSOR MILL
Practice Address - State:MD
Practice Address - Zip Code:21244
Practice Address - Country:US
Practice Address - Phone:410-747-4711
Practice Address - Fax:410-747-4766
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0019058207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD5433193P0001Medicaid
MD2698Medicare PIN