Provider Demographics
NPI:1013902287
Name:TSAO, AUDREY K (MD)
Entity Type:Individual
Prefix:MS
First Name:AUDREY
Middle Name:K
Last Name:TSAO
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 1:4915 HAMPDEN LN UNIT 206
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-3700
Mailing Address - Country:US
Mailing Address - Phone:301-938-5483
Mailing Address - Fax:301-618-5722
Practice Address - Street 1:2101 E JEFFERSON ST
Practice Address - Street 2:STE 100
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-4908
Practice Address - Country:US
Practice Address - Phone:602-616-1434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILD36080175207X00000X
MS13303207X00000X
VA0101255327207X00000X
DCMD041822207X00000X
AZ34748207X00000X
MDD40813207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP00289660OtherRAILROAD MEDICARE
AZ020501Medicaid
AZ1743191OtherUNITED HEALTHCARE
AZ2Z3734OtherHEALTHNET
AZ1013902287OtherBCBS OUT OF AREA
AZ4502258OtherAETNA
AZ020521OtherAHCCCS
AZP00289660OtherRAILROAD MEDICARE
AZ2Z3734OtherHEALTHNET
AZZWCLCJMedicare PIN
AZ4502258OtherAETNA