Provider Demographics
NPI:1972733590
Name:HEALEY, LETHA MARY (MD)
Entity Type:Individual
Prefix:
First Name:LETHA
Middle Name:MARY
Last Name:HEALEY
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 1:10206 GREENFIELD ST
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-4128
Mailing Address - Country:US
Mailing Address - Phone:240-743-4125
Mailing Address - Fax:
Practice Address - Street 1:1458 ADDISON RD S
Practice Address - Street 2:
Practice Address - City:CAPITOL HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20743-4413
Practice Address - Country:US
Practice Address - Phone:301-324-1500
Practice Address - Fax:301-324-6405
Is Sole Proprietor?:No
Enumeration Date:2009-07-16
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0062456207R00000X, 207RI0200X
DCMD33271207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD108358900Medicaid