Provider Demographics
NPI:1659370039
Name:THOMAS, MICHELLE DENISE (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:DENISE
Last Name: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:PO BOX 15609
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-0609
Mailing Address - Country:US
Mailing Address - Phone:301-390-5704
Mailing Address - Fax:301-464-7921
Practice Address - Street 1:12172 CENTRAL AVE
Practice Address - Street 2:#100
Practice Address - City:MITCHELLVILLE
Practice Address - State:MD
Practice Address - Zip Code:20721-1900
Practice Address - Country:US
Practice Address - Phone:307-390-5704
Practice Address - Fax:301-464-7921
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD41401208D00000X, 207RC0200X
VA0101056850208D00000X
DCMD19906208D00000X
GA0734062086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
104768800OtherDEPT OF LABOR/FEDERAL WORKMAN'S COMP
MD348211100Medicaid
0003OtherCAREFIRST
3112384OtherAETNA HMO
35198002OtherCAREFIRST
MD384211100Medicaid
4348841OtherAETNA PPO
35198002OtherCAREFIRST
F50617Medicare UPIN
297YMedicare PIN