Provider Demographics
NPI:1538105697
Name:ABERNATHY, THOMAS WALTER JR (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:WALTER
Last Name:ABERNATHY
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:700 GEIPE RD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-4147
Mailing Address - Country:US
Mailing Address - Phone:410-247-7500
Mailing Address - Fax:410-737-8424
Practice Address - Street 1:700 GEIPE RD
Practice Address - Street 2:SUITE 230
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-4147
Practice Address - Country:US
Practice Address - Phone:410-247-7500
Practice Address - Fax:410-737-8424
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2014-08-08
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Provider Licenses
StateLicense IDTaxonomies
MDD0061137207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD008505700Medicaid
MD129401YLJMedicare PIN
MD008505700Medicaid