Healthcare Provider Details

I. General information

NPI: 1568089399
Provider Name (Legal Business Name): THOMAS LAURENCE RICHIE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2020
Last Update Date: 06/27/2020
Certification Date: 06/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9800 MEDICAL CENTER DR STE A209
ROCKVILLE MD
20850-6395
US

IV. Provider business mailing address

4053 HOBBS HILL RD
GLENELG MD
21737-9521
US

V. Phone/Fax

Practice location:
  • Phone: 301-770-3222
  • Fax: 301-770-5554
Mailing address:
  • Phone: 301-466-7943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberD0041172
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: