Provider Demographics
NPI:1992948277
Name:THAMMASUVIMOL, GRACE (MD)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:THAMMASUVIMOL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 THOMAS JOHNSON DR STE 200
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-6200
Mailing Address - Country:US
Mailing Address - Phone:301-695-8390
Mailing Address - Fax:301-694-7906
Practice Address - Street 1:170 THOMAS JOHNSON DR STE 200
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-6200
Practice Address - Country:US
Practice Address - Phone:301-695-8390
Practice Address - Fax:301-694-7906
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-15
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD723572084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry