Provider Demographics
NPI: | 1730137175 |
---|---|
Name: | DO, THIEU M (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | THIEU |
Middle Name: | M |
Last Name: | DO |
Suffix: | |
Gender: | M |
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: | 7611 LITTLE RIVER TPKE |
Mailing Address - Street 2: | SUITE 108 W |
Mailing Address - City: | ANNANDALE |
Mailing Address - State: | VA |
Mailing Address - Zip Code: | 22003-2602 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 703-658-7060 |
Mailing Address - Fax: | 703-658-3150 |
Practice Address - Street 1: | 7611 LITTLE RIVER TPKE |
Practice Address - Street 2: | SUITE 108 W |
Practice Address - City: | ANNANDALE |
Practice Address - State: | VA |
Practice Address - Zip Code: | 22003-2602 |
Practice Address - Country: | US |
Practice Address - Phone: | 703-658-7060 |
Practice Address - Fax: | 703-658-3150 |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2006-05-05 |
Last Update Date: | 2021-03-29 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
VA | 0101049539 | 207RP1001X, 207RC0200X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207RC0200X | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine |
No | 207RP1001X | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
VA | 005868157 | Medicaid | |
VA | 005868157 | Medicaid |