MEDICARE: DR. MICHELLE DENISE THOMAS MD

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	208D00000X	General Practice Physician	D41401	MD
2	208D00000X	General Practice Physician	0101056850	VA
3	208D00000X	General Practice Physician	MD19906	DC
4	2086S0102X	Surgical Critical Care Physician	073406	GA
5	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	D41401	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	104768800	OTHER	DEPT OF LABOR/FEDERAL WORKMAN'S COMP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	0003	OTHER	CAREFIRST
4	3112384	OTHER	AETNA HMO
5	35198002	OTHER	CAREFIRST
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	4348841	OTHER	AETNA PPO

General Provider Information

NPI Number	:	1659370039
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHELLE DENISE THOMAS MD

Provider Business Mailing Address
First Line	:	PO BOX 15609
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20003-0609
Country	:	US
Telephone Number	:	301-390-5704
Fax Number	:	301-464-7921

Provider Business Practice Location Address
First Line	:	12172 CENTRAL AVE
Second Line	:	#100
City	:	MITCHELLVILLE
State	:	MD
Zip	:	20721-1900
Country	:	US
Telephone Number	:	307-390-5704
Fax Number	:	301-464-7921

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

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	03/01/2021

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Directions to “ DR. MICHELLE DENISE THOMAS MD” Practice Location

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