Provider Demographics
NPI:1659360469
Name:THANWY, NOMAN (MD)
Entity type:Individual
Prefix:
First Name:NOMAN
Middle Name:
Last Name:THANWY
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 1:503 BYRN ST STE 1
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21613-1917
Mailing Address - Country:US
Mailing Address - Phone:410-221-7770
Mailing Address - Fax:410-221-7863
Practice Address - Street 1:503 BYRN ST STE 1
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21613-1917
Practice Address - Country:US
Practice Address - Phone:410-221-7770
Practice Address - Fax:410-221-7863
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD47924207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD110202098OtherRR MEDICARE
MD110202098OtherPALMETTO GBA/RAILROAD MEDICARE
E6360003OtherFEDERAL BS
MD68620302OtherCAREFIRST BS
MD102800600Medicaid
MD68620302OtherCAREFIRST BS
MD102800600Medicaid