Provider Demographics
NPI:1912972787
Name:THOMAS, SHERIDA LESLIE (MD)
Entity Type:Individual
Prefix:DR
First Name:SHERIDA
Middle Name:LESLIE
Last Name:THOMAS
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 1:8926 WOODYARD RD
Mailing Address - Street 2:STE 301
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-4220
Mailing Address - Country:US
Mailing Address - Phone:301-856-3670
Mailing Address - Fax:301-856-0129
Practice Address - Street 1:7801 OLD BRANCH AVE
Practice Address - Street 2:STE 300
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-1608
Practice Address - Country:US
Practice Address - Phone:301-856-6718
Practice Address - Fax:301-856-6722
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0034670174400000X
VA0101040481174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1912972787Medicaid
MD809940501Medicaid
VAP00665991Medicare PIN
MDP00613337Medicare PIN
VA1912972787Medicaid
MD809940501Medicaid
VA300075501Medicare PIN
MD221L259TMedicare PIN