Healthcare Provider Details

I. General information

NPI: 1912972787
Provider Name (Legal Business Name): SHERIDA LESLIE THOMAS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 03/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7801 OLD BRANCH AVE STE 300
CLINTON MD
20735-1608
US

IV. Provider business mailing address

8926 WOODYARD RD STE 301
CLINTON MD
20735-4220
US

V. Phone/Fax

Practice location:
  • Phone: 301-856-6718
  • Fax: 301-856-6722
Mailing address:
  • Phone: 301-856-3670
  • Fax: 301-856-0129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberD0034670
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number0101040481
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: