Healthcare Provider Details

I. General information

NPI: 1801176060
Provider Name (Legal Business Name): JEAN THERMOLICE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2011
Last Update Date: 11/27/2023
Certification Date: 10/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 GALLOWS RD
FALLS CHURCH VA
22042-3300
US

IV. Provider business mailing address

3300 GALLOWS RD PHYSCIAN BILLING
FALLS CHURCH VA
22042-3307
US

V. Phone/Fax

Practice location:
  • Phone: 703-776-4001
  • Fax: 703-776-7113
Mailing address:
  • Phone: 703-776-2545
  • Fax: 703-776-2917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number0101249363
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: