Boonyong P Thada, M.D., P.a.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

D0019823 Issued in MD

Legal business name

BOONYONG P THADA, M.D., P.A.

Practice address

5356 Reisterstown Rd
Baltimore, MD 21215-4426

Phone

(410) 358-5111

Fax

(410) 358-9169

NPI assigned

Oct 14, 2010

Organization subpart

Yes

Parent organization

BOONYONG P THADA, M.D., P.A.As reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Boonyong P Thada, M.D.

Title

Physician

Phone

(410) 358-5111

Specialties & licenses 1

Addresses

Other identifiers 1

Part of

Boonyong P Thada MD

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1287014400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1287446400000",
    "number": "1194035097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5356 REISTERSTOWN RD",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212154426",
            "telephone_number": "410-358-5111",
            "fax_number": "410-358-9169"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5356 REISTERSTOWN RD",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212154426",
            "telephone_number": "410-358-5111",
            "fax_number": "410-358-9169"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOONYONG P THADA, M.D., P.A.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BOONYONG P THADA, M.D., P.A.",
        "enumeration_date": "2010-10-14",
        "last_updated": "2010-10-19",
        "status": "A",
        "authorized_official_last_name": "THADA",
        "authorized_official_first_name": "BOONYONG",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "410-358-5111",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "MD",
            "license": "D0019823",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "220561100",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carrie Shadonna Boone, LCSW-C
• Karen M Boone, LCSW-C
• Mya Ariel Boone
• Stephanie R Boone, DDS
• Romsai T Boonyasai, M.D.
• Christina Boord, CRNP
• Carole M Booth, MD
• Ian Booth, PHARMD
• Jasmine Michelle Booth
• Lauren Booth, CPNP-AC

• Internal Medicine Physician in Baltimore, MD
• Providers in Baltimore, MD by specialty
• Internal Medicine Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.