Provider Demographics
NPI:1366445942
Name:STAUCH, THOMAS E (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:E
Last Name:STAUCH
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 1:510 IDLEWILD AVE
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-3824
Mailing Address - Country:US
Mailing Address - Phone:410-820-8226
Mailing Address - Fax:410-820-8405
Practice Address - Street 1:510 IDLEWILD AVE
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-3824
Practice Address - Country:US
Practice Address - Phone:410-820-8226
Practice Address - Fax:410-820-8405
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0044388207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CF170013OtherCAREFIRST
MD064071900Medicaid
CF170013OtherCAREFIRST
494162ZP1Medicare PIN