Provider Demographics
NPI:1770738023
Name:THOMAS, MAZHUVANCHERY ABRAHAM
Entity type:Individual
Prefix:DR
First Name:MAZHUVANCHERY
Middle Name:ABRAHAM
Last Name:THOMAS
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:M.A.
Other - Middle Name:
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2900 ANDOVER RD
Mailing Address - Street 2:
Mailing Address - City:FOREST HILL
Mailing Address - State:MD
Mailing Address - Zip Code:21050-2011
Mailing Address - Country:US
Mailing Address - Phone:410-557-8166
Mailing Address - Fax:
Practice Address - Street 1:2900 ANDOVER RD
Practice Address - Street 2:
Practice Address - City:FOREST HILL
Practice Address - State:MD
Practice Address - Zip Code:21050-2011
Practice Address - Country:US
Practice Address - Phone:410-557-8166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-28
Last Update Date:2008-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD035149E207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine