Provider Demographics
NPI:1811370091
Name:LE, MICHELLE THUY (DPM)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:THUY
Last Name:LE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 BREWSTER ST
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-4474
Mailing Address - Country:US
Mailing Address - Phone:401-729-2000
Mailing Address - Fax:401-729-2916
Practice Address - Street 1:11801 ROCKVILLE PIKE STE 105
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-2714
Practice Address - Country:US
Practice Address - Phone:301-881-6222
Practice Address - Fax:301-881-1639
Is Sole Proprietor?:No
Enumeration Date:2015-07-07
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILPR00147213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIRES000Medicare UPIN