Provider Demographics
NPI:1770648370
Name:KRISANDA, THOMAS J (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:KRISANDA
Suffix:
Gender:M
Credentials:MD
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5401 OLD COURT ROAD
Mailing Address - Street 2:NORTHWEST HOSPITAL EMERGENCY DEPT.
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133
Mailing Address - Country:US
Mailing Address - Phone:410-521-5950
Mailing Address - Fax:410-828-6004
Practice Address - Street 1:5401 OLD COURT ROAD
Practice Address - Street 2:NORTHWEST HOSPITAL EMERGENCY DEPT.
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21133
Practice Address - Country:US
Practice Address - Phone:410-521-5950
Practice Address - Fax:410-828-6004
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD043477E207P00000X
PAMD-043477-E207P00000X
MDD0053345207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD246601500Medicaid
MD75859901OtherBLUE SHIELD
MD930078599OtherRAILROAD MED