Provider Demographics
NPI:1639108145
Name:AYALA, TOMAS H (MD)
Entity Type:Individual
Prefix:
First Name:TOMAS
Middle Name:H
Last Name:AYALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 KEY HWY
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21230-5116
Mailing Address - Country:US
Mailing Address - Phone:410-230-7800
Mailing Address - Fax:410-230-7801
Practice Address - Street 1:1420 KEY HWY
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21230-5116
Practice Address - Country:US
Practice Address - Phone:410-230-7800
Practice Address - Fax:410-230-7801
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0058914207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP00365054OtherRAILROAD MEDICARE
MD410705500Medicaid
MDH3630445Medicare PIN
MDP00365054OtherRAILROAD MEDICARE