MEDICARE: DR. MICHAEL RICHARD THOLEN M.D.

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	208600000X	Surgery Physician	D0081849	MD
2	208D00000X	General Practice Physician	D0081849	MD
3	207Q00000X	Family Medicine Physician	D0081849	MD
4	207P00000X	Emergency Medicine Physician	D0081849	MD

General Provider Information

NPI Number	:	1215294434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL RICHARD THOLEN M.D.

Provider Business Mailing Address
First Line	:	2406 CONNOR CIR
Second Line	:
City	:	MOUNT AIRY
State	:	MD
Zip	:	21771-5960
Country	:	US
Telephone Number	:	612-850-5919
Fax Number	:	301-682-3515

Provider Business Practice Location Address
First Line	:	5100 BUCKEYSTOWN PIKE STE 186
Second Line	:
City	:	FREDERICK
State	:	MD
Zip	:	21704-8337
Country	:	US
Telephone Number	:	301-682-8888
Fax Number	:

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

Provider Enumeration Date	:	04/12/2012
Last Update Date	:	09/24/2025

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