Provider Demographics
NPI:1447880919
Name:MUHA, THOMAS (PHD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:MUHA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-2707
Mailing Address - Country:US
Mailing Address - Phone:443-454-7274
Mailing Address - Fax:
Practice Address - Street 1:1410 FOREST DR STE 24
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21403-1446
Practice Address - Country:US
Practice Address - Phone:443-454-7274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1241103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1241OtherMD BOARD OF PSYCHOLOGY