MEDICARE: JAMES MICHAEL THIEL MD, MPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	0101033903	VA

General Provider Information

NPI Number	:	1174657076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES MICHAEL THIEL MD, MPH

Provider Business Mailing Address
First Line	:	3002 CUNNINGHAM DR
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22309-2207
Country	:	US
Telephone Number	:	703-489-0289
Fax Number	:	703-799-2183

Provider Business Practice Location Address
First Line	:	3002 CUNNINGHAM DR
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22309-2207
Country	:	US
Telephone Number	:	703-489-0289
Fax Number	:	703-799-2183

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	07/08/2007

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