Doctor Name: | SELENA THOMAS |
NPI Number: | 1265615116 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MD |
License Number: | P21883 |
Business Practice Address: | 7190 Crestwood Boulevard Frederick, MD - 217033901 |
Business Phone Number: | 2405291765 |
Business Fax Number: | 2405291760 |
Mailing Address: | 7190 Crestwood Blvd, FREDERICK |
State: | MD |
Postal Code: | 217037314 |
Phone Number: | 2405291765 |
Fax Number: | 2405291760 |
NPI Enumeration Date: | 12/14/2007 |
NPI Last Update Date: | 10/19/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | P21883 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | MD |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |