Provider Demographics
NPI:1760777692
Name:TOM, PATRICIA (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:
Last Name:TOM
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 1:1829 REISTERSTOWN RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-6320
Mailing Address - Country:US
Mailing Address - Phone:410-602-9850
Mailing Address - Fax:
Practice Address - Street 1:16 GREENMEADOW DR
Practice Address - Street 2:SUITE G105
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-3200
Practice Address - Country:US
Practice Address - Phone:410-561-5773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0037898207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDE58564Medicare UPIN