Provider Demographics
NPI:1689650780
Name:MEAD, MICHELLE A (MD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:A
Last Name:MEAD
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 10778
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20914-0778
Mailing Address - Country:US
Mailing Address - Phone:301-384-2338
Mailing Address - Fax:301-384-2338
Practice Address - Street 1:1221 MERCANTILE LN
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-5374
Practice Address - Country:US
Practice Address - Phone:301-816-2424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-20
Last Update Date:2021-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD32976207P00000X
CT56892207P00000X
VA0101053834207P00000X
MDD0036396207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC024557900Medicaid
DC44330020OtherBLUECROSS BLUESHIELD
E38360Medicare UPIN
DC44330020OtherBLUECROSS BLUESHIELD