Healthcare Provider Details

I. General information

NPI: 1831033083
Provider Name (Legal Business Name): JOSHUA DAVID THAYER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2026
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2703 MARTIN LUTHER KING JR AVE SE STOP 7201
WASHINGTON DC
20593-7201
US

IV. Provider business mailing address

9066 BALTIMORE ST
SAVAGE MD
20763-9647
US

V. Phone/Fax

Practice location:
  • Phone: 202-372-4100
  • Fax:
Mailing address:
  • Phone: 571-488-0041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: