Provider Demographics
NPI:1649229519
Name:BIONDO, THOMAS A (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:A
Last Name:BIONDO
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 1:251 LEWIS LANE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HAVRE DE GRACE
Mailing Address - State:MD
Mailing Address - Zip Code:21078-3753
Mailing Address - Country:US
Mailing Address - Phone:410-939-4477
Mailing Address - Fax:410-939-1153
Practice Address - Street 1:251 LEWIS LANE
Practice Address - Street 2:SUITE 201
Practice Address - City:HAVRE DE GRACE
Practice Address - State:MD
Practice Address - Zip Code:21078-3753
Practice Address - Country:US
Practice Address - Phone:410-939-4477
Practice Address - Fax:410-939-1153
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0042800207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD145388000OtherWCDL
MD52483401OtherBS OF MARYLAND
MDW724001OtherDELMARVA HEALTH PLAN
MD348561700Medicaid
DCW724001OtherBS OF DC
PA000424675OtherBS OF PA
MD20225000000OtherPHN
MDF24065Medicare UPIN
MD20225000000OtherPHN