Provider Demographics
NPI:1568535326
Name:RADCLIFFE M THOMAS MD PA
Entity Type:Organization
Organization Name:RADCLIFFE M THOMAS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RADCLIFFE
Authorized Official - Middle Name:M
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-542-7700
Mailing Address - Street 1:4000 W NORTHERN PKWY
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-4473
Mailing Address - Country:US
Mailing Address - Phone:410-542-7700
Mailing Address - Fax:410-542-4706
Practice Address - Street 1:4000 W NORTHERN PKWY
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-4473
Practice Address - Country:US
Practice Address - Phone:410-542-7700
Practice Address - Fax:410-542-4706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD42683207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD204571100Medicaid
MDF51511Medicare UPIN
MD132QMedicare PIN