Provider Demographics
NPI:1255318242
Name:THAI, CAM -TU THI (MD)
Entity Type:Individual
Prefix:DR
First Name:CAM -TU
Middle Name:THI
Last Name:THAI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:PROF
Other - First Name:CAM-TU
Other - Middle Name:THI
Other - Last Name:THAI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:12418 ROCK RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-5726
Mailing Address - Country:US
Mailing Address - Phone:703-241-2412
Mailing Address - Fax:703-241-5743
Practice Address - Street 1:6316 CASTLE PL
Practice Address - Street 2:SUITE 301
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22044-1906
Practice Address - Country:US
Practice Address - Phone:703-241-2412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101054907174400000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
2697907OtherAETNA HMO
541999294OtherUNITEDHEALTHCARE
VA317926OtherANTHEM
541999294OtherTRICARE
VA5846013Medicaid
VAF145OtherCAREFIRST BC BS
7289333OtherAETNA PPO
VAH22894Medicare UPIN
VAG01839 M01Medicare ID - Type Unspecified