Provider Demographics
NPI:1982661211
Name:HUISMAN, THOMAS K (MD)
Entity Type:Individual
Prefix:PROF
First Name:THOMAS
Middle Name:K
Last Name:HUISMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:25 CROSSROADS DR
Mailing Address - Street 2:SUITE 306
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-5421
Mailing Address - Country:US
Mailing Address - Phone:443-738-2872
Mailing Address - Fax:443-738-2713
Practice Address - Street 1:7704 MATAPEAKE BUSINESS DR
Practice Address - Street 2:SUITE 310
Practice Address - City:BRANDYWINE
Practice Address - State:MD
Practice Address - Zip Code:20613-3023
Practice Address - Country:US
Practice Address - Phone:301-868-0202
Practice Address - Fax:301-868-2331
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0051808208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD006300200Medicaid
MD000533FY1DMedicare PIN
MD336127YYA6Medicare PIN
F35484Medicare UPIN
MD336127YYA6Medicare PIN