Provider Demographics
NPI:1467674937
Name:KOSO-THOMAS, MARION WENDY (MD)
Entity Type:Individual
Prefix:DR
First Name:MARION
Middle Name:WENDY
Last Name:KOSO-THOMAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3815 TERRAWOOD CT
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20853-3288
Mailing Address - Country:US
Mailing Address - Phone:301-570-4064
Mailing Address - Fax:
Practice Address - Street 1:3815 TERRAWOOD CT
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20853-3288
Practice Address - Country:US
Practice Address - Phone:301-570-4064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD0056182208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics