Provider Demographics
NPI:1225394091
Name:THIBAULT, ALAIN (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAIN
Middle Name:
Last Name:THIBAULT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9607 SINGLETON DR
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-2464
Mailing Address - Country:US
Mailing Address - Phone:301-564-5757
Mailing Address - Fax:
Practice Address - Street 1:9607 SINGLETON DR
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-2464
Practice Address - Country:US
Practice Address - Phone:301-564-5757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-06
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101052822207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology