Provider Demographics
NPI:1851999106
Name:LE, THANHTHAO HOANG (PA-C)
Entity Type:Individual
Prefix:
First Name:THANHTHAO
Middle Name:HOANG
Last Name:LE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:THAO
Other - Middle Name:
Other - Last Name:LE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:5100 BUCKEYSTOWN PIKE STE 186
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21704-8337
Mailing Address - Country:US
Mailing Address - Phone:301-682-8888
Mailing Address - Fax:301-682-3515
Practice Address - Street 1:15001 SHADY GROVE RD STE 300
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-6353
Practice Address - Country:US
Practice Address - Phone:301-825-9701
Practice Address - Fax:301-762-5678
Is Sole Proprietor?:No
Enumeration Date:2020-10-09
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MDC0008066363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program