Provider Demographics
NPI:1598749228
Name:THIEDE, CHAU L (MD)
Entity Type:Individual
Prefix:
First Name:CHAU
Middle Name:L
Last Name:THIEDE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:CHAU
Other - Middle Name:L
Other - Last Name:LAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2023 DEXTER DR
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22043
Mailing Address - Country:US
Mailing Address - Phone:703-650-8052
Mailing Address - Fax:
Practice Address - Street 1:6711 WHITTIER AVENUE
Practice Address - Street 2:SUITE 101
Practice Address - City:MCLEAN
Practice Address - State:VA
Practice Address - Zip Code:22101
Practice Address - Country:US
Practice Address - Phone:703-356-5722
Practice Address - Fax:703-734-3823
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101222693208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
H04828Medicare UPIN