Provider Demographics
NPI:1700188109
Name:HTIN, THANDA (MD)
Entity Type:Individual
Prefix:
First Name:THANDA
Middle Name:
Last Name:HTIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2790 BROADWAY
Mailing Address - Street 2:APT 2G
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-2846
Mailing Address - Country:US
Mailing Address - Phone:347-886-8539
Mailing Address - Fax:
Practice Address - Street 1:2790 BROADWAY
Practice Address - Street 2:APT 2G
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-2846
Practice Address - Country:US
Practice Address - Phone:347-886-8539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-17
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD441438207R00000X
NY259403207R00000X
CT54493207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine