Healthcare Provider Details

I. General information

NPI: 1023060027
Provider Name (Legal Business Name): THAIS DORRYNNE WEIBEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 01/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11055 LITTLE PATUXENT PKWY SUITE 109
COLUMBIA MD
21044
US

IV. Provider business mailing address

4509 ROSEDALE AVE
BETHSEDA MD
20814
US

V. Phone/Fax

Practice location:
  • Phone: 410-977-1928
  • Fax: 410-977-1929
Mailing address:
  • Phone: 410-997-1928
  • Fax: 410-997-1929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberD0057645
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: