=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245245802
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | THOMAS T. LE M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/30/2006
-----------------------------------------------------
Last Update Date | 04/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4785 DORSEY HALL DR STE 111
-----------------------------------------------------
City | ELLICOTT CITY
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21042-7862
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 877-917-3223
-----------------------------------------------------
Fax | 443-219-0758
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4785 DORSEY HALL DR STE 111
-----------------------------------------------------
City | ELLICOTT CITY
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21042-7862
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 877-917-3223
-----------------------------------------------------
Fax | 443-219-0758
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Y00000X
-----------------------------------------------------
Taxonomy Name | Otolaryngology Physician
-----------------------------------------------------
License Number | D61873
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207YS0123X
-----------------------------------------------------
Taxonomy Name | Facial Plastic Surgery Physician
-----------------------------------------------------
License Number | D61873
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------