Provider Demographics
NPI:1720113251
Name:THOMAS, JERRY R II (MD)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:R
Last Name:THOMAS
Suffix:II
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 1:11055 LITTLE PATUXENT PKWY STE L1
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-2897
Mailing Address - Country:US
Mailing Address - Phone:410-740-7030
Mailing Address - Fax:410-740-7033
Practice Address - Street 1:11055 LITTLE PATUXENT PKWY STE L1
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2897
Practice Address - Country:US
Practice Address - Phone:410-740-7030
Practice Address - Fax:410-740-7033
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0050349207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1073960OtherCIGNA
MD5017704OtherAETNA PPO
MD75866504OtherBCBS MD
MD1059004OtherAETNA HMO
MD202970OtherANTHEM
MD699718000Medicaid
DC9450-0004OtherBCBS NCA
MDP00265255OtherRAILROAD MEDICARE
MD493892OtherNCPPO
MDP00265255OtherRAILROAD MEDICARE
DC9450-0004OtherBCBS NCA