Provider Demographics
NPI:1467549477
Name:HYDE, THOMAS MICHAEL (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:MICHAEL
Last Name:HYDE
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4701 WILLARD AVENUE
Mailing Address - Street 2:SUITE 233
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815
Mailing Address - Country:US
Mailing Address - Phone:301-652-8777
Mailing Address - Fax:301-652-0856
Practice Address - Street 1:4701 WILLARD AVENUE
Practice Address - Street 2:SUITE 233
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815
Practice Address - Country:US
Practice Address - Phone:301-652-8777
Practice Address - Fax:301-652-0856
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00376432084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
414431Medicare UPIN
B94744Medicare ID - Type Unspecified