Healthcare Provider Details

I. General information

NPI: 1376624437
Provider Name (Legal Business Name): THOMAS FREDERICK QUALEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

C/O PRICE MEDICAL 1330 NEW HAMPSHIRE AVE, NW #121
WASHINGTON DC
20036
US

IV. Provider business mailing address

1702 P ST NW
WASHINGTON DC
20036-1326
US

V. Phone/Fax

Practice location:
  • Phone: 202-463-0220
  • Fax: 202-463-0222
Mailing address:
  • Phone: 202-210-5833
  • Fax: 202-463-0220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberMD32275
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: