Provider Demographics
NPI:1518182377
Name:OLSON, THUY LAN THI (MD)
Entity Type:Individual
Prefix:DR
First Name:THUY LAN
Middle Name:THI
Last Name:OLSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4197C WINCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:VA
Mailing Address - Zip Code:20115-3252
Mailing Address - Country:US
Mailing Address - Phone:540-422-5782
Mailing Address - Fax:540-360-9889
Practice Address - Street 1:4197C WINCHESTER RD
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:VA
Practice Address - Zip Code:20115-3252
Practice Address - Country:US
Practice Address - Phone:540-422-5782
Practice Address - Fax:540-360-9889
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101252075207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036122106-1Medicaid
VA1518182377Medicaid
MO1518182377Medicaid
ILIL1682043Medicare PIN