Provider Demographics
NPI:1508298423
Name:THOMAS, DUANE EDWARD (PHD)
Entity Type:Individual
Prefix:DR
First Name:DUANE
Middle Name:EDWARD
Last Name:THOMAS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 FREDERICK ROAD
Mailing Address - Street 2:SUITE 158
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-4633
Mailing Address - Country:US
Mailing Address - Phone:410-747-1265
Mailing Address - Fax:410-744-7981
Practice Address - Street 1:405 FREDERICK ROAD
Practice Address - Street 2:SUITE 158
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-4633
Practice Address - Country:US
Practice Address - Phone:410-747-1265
Practice Address - Fax:410-744-7981
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-01
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05557103T00000X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD100155800Medicaid