Healthcare Provider Details

I. General information

NPI: 1518608231
Provider Name (Legal Business Name): THAYSE GRACIELLA LOZOVOY MADSEN BARBOSA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 LOCH RAVEN BLVD RUSSELL MORGAN BUILDING, SUITE 300
BALTIMORE MD
21239
US

IV. Provider business mailing address

5601 LOCH RAVEN BLVD RUSSELL MORGAN BUILDING, SUITE 300
BALTIMORE MD
21239
US

V. Phone/Fax

Practice location:
  • Phone: 443-444-5600
  • Fax: 866-639-5350
Mailing address:
  • Phone: 443-444-5600
  • Fax: 866-639-5350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD010449
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: