Healthcare Provider Details

I. General information

NPI: 1962432260
Provider Name (Legal Business Name): MICHAEL MIN-SHYUE LAI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 04/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5454 WISCONSIN AVE STE 650
CHEVY CHASE MD
20815
US

IV. Provider business mailing address

7501 GREENWAY CENTER DR 300
GREENBELT MD
20770-3514
US

V. Phone/Fax

Practice location:
  • Phone: 301-656-8100
  • Fax: 301-652-2957
Mailing address:
  • Phone: 301-474-4679
  • Fax: 301-474-7182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number0101241092
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberD0065946
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD36645
License Number StateDC
# 4
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberMD36645
License Number StateDC
# 5
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number0101241092
License Number StateVA
# 6
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberD0065946
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: