Healthcare Provider Details

I. General information

NPI: 1780615427
Provider Name (Legal Business Name): CHRISTIANE THEDA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N WOLFE ST NEONATOLOGY - NELSON 2-133
BALTIMORE MD
21287-0005
US

IV. Provider business mailing address

5819 WINDING OAKS CT
FREDERICK MD
21704-6865
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-5259
  • Fax:
Mailing address:
  • Phone: 301-360-9676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License NumberD0039805
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0039805
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberD0039805
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: