MEDICARE: DR. MIMI W THEIN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	MD045795	DC
2	2084P0804X	Child & Adolescent Psychiatry Physician	MD045795	DC

General Provider Information

NPI Number	:	1639158249
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MIMI W THEIN M.D.

Provider Business Mailing Address
First Line	:	US DEPT OF STATE M/MED/QM SA-1
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20522-0102
Country	:	US
Telephone Number	:	617-680-4168
Fax Number	:

Provider Business Practice Location Address
First Line	:	US DEPT OF STATE M/MED/QM SA-1
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20522-2006
Country	:	US
Telephone Number	:	617-680-4168
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2006
Last Update Date	:	11/28/2024

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