Healthcare Provider Details

I. General information

NPI: 1568517068
Provider Name (Legal Business Name): THOMAS JAMES DEGRABA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 04/17/2024
Certification Date: 04/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 WISCONSIN AVE NEUROLOGY DEPT BUILDING 9 2ND FLOOR
BETHESDA MD
20850-3666
US

IV. Provider business mailing address

WALTER REED NTL MIL MED CNTR 8901 WISCONSIN AVE BLDG 51
BETHESDA MD
20889-0001
US

V. Phone/Fax

Practice location:
  • Phone: 13-319-3603
  • Fax:
Mailing address:
  • Phone: 301-319-3603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License NumberD0037839
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: