Provider Demographics
NPI:1578704813
Name:THIBIN SANTHA MD, PC
Entity Type:Organization
Organization Name:THIBIN SANTHA MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THIBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-326-6978
Mailing Address - Street 1:PO BOX 2661
Mailing Address - Street 2:
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-2661
Mailing Address - Country:US
Mailing Address - Phone:410-326-6978
Mailing Address - Fax:410-394-2805
Practice Address - Street 1:14090 HG TRUEMAN ROAD
Practice Address - Street 2:SUITE 1300, BOX 93
Practice Address - City:SOLOMONS
Practice Address - State:MD
Practice Address - Zip Code:20688-3151
Practice Address - Country:US
Practice Address - Phone:410-326-6978
Practice Address - Fax:410-394-2805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-17
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0064324207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty