Provider Demographics
NPI:1760575443
Name:ROESEL, THOMAS (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:ROESEL
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7810 FALSTAFF ROAD
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-2725
Mailing Address - Country:US
Mailing Address - Phone:703-790-0395
Mailing Address - Fax:703-790-0395
Practice Address - Street 1:7810 FALSTAFF RD
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-2725
Practice Address - Country:US
Practice Address - Phone:703-790-0395
Practice Address - Fax:703-790-0395
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101047443207R00000X
DCMD20793207R00000X
TXG6003207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine