Healthcare Provider Details

I. General information

NPI: 1245245802
Provider Name (Legal Business Name): THOMAS T. LE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4785 DORSEY HALL DR STE 111
ELLICOTT CITY MD
21042-7862
US

IV. Provider business mailing address

4785 DORSEY HALL DR STE 111
ELLICOTT CITY MD
21042-7862
US

V. Phone/Fax

Practice location:
  • Phone: 877-917-3223
  • Fax: 443-219-0758
Mailing address:
  • Phone: 877-917-3223
  • Fax: 443-219-0758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberD61873
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License NumberD61873
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: