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NPI Code Detail

MEDICARE: VICTORIA THEE PA-C

MEDICARE: VICTORIA THEE PA-C
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
1363A00000XPhysician AssistantC0009233MD

General Provider Information

NPI Number : 1245093806
Entity Type Code : Individual
Provider Name (Legal Business Name) : VICTORIA THEE PA-C
Provider Business Mailing Address
First Line : 12800 MIDDLEBROOK RD STE 400
Second Line :
City : GERMANTOWN
State : MD
Zip : 20874-5282
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 12800 MIDDLEBROOK RD STE 400
Second Line :
City : GERMANTOWN
State : MD
Zip : 20874-5282
Country : US
Telephone Number : 301-515-2901
Fax Number : 866-701-4905
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/05/2024
Last Update Date : 02/05/2024

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Directions to “ VICTORIA THEE PA-C” Practice Location

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