Healthcare Provider Details

I. General information

NPI: 1912082025
Provider Name (Legal Business Name): HELEN M THACKRAY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MICHIGAN AVE NW
WASHINGTON DC
20010-2978
US

IV. Provider business mailing address

101 ORCHARD RIDGE DR SUITE 1E
GAITHERSBURG MD
20878-1917
US

V. Phone/Fax

Practice location:
  • Phone: 202-884-2182
  • Fax:
Mailing address:
  • Phone: 240-243-1230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD22023
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: