Provider Demographics
NPI:1033329305
Name:RAYBURN, THOMAS MONROE III (PHD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:MONROE
Last Name:RAYBURN
Suffix:III
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 HAREWOOD RD NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20064-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4001 HAREWOOD RD NE
Practice Address - Street 2:126 O'BOYLE HALL
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20064-0001
Practice Address - Country:US
Practice Address - Phone:202-319-6323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC1000076103TC0700X
MD03678103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical