Provider Demographics
NPI:1780811448
Name:LE, THAO PHUONG (DO)
Entity type:Individual
Prefix:DR
First Name:THAO
Middle Name:PHUONG
Last Name:LE
Suffix:
Gender:
Credentials:DO
Other - Prefix:DR
Other - First Name:TERRY
Other - Middle Name:PHUONG
Other - Last Name:LE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:301 S OKELLY AVE
Mailing Address - Street 2:
Mailing Address - City:ELON
Mailing Address - State:NC
Mailing Address - Zip Code:27244-9382
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:301 S OKELLY AVE
Practice Address - Street 2:
Practice Address - City:ELON
Practice Address - State:NC
Practice Address - Zip Code:27244-9382
Practice Address - Country:US
Practice Address - Phone:336-278-7230
Practice Address - Fax:336-538-6506
Is Sole Proprietor?:No
Enumeration Date:2009-06-19
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0116021227207Q00000X
NC2012-01541207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine