1255318242 NPI number — DR. CAM -TU THI THAI M.D

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255318242 NPI number — DR. CAM -TU THI THAI M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THAI
Provider First Name:
CAM -TU
Provider Middle Name:
THI
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
THAI
Provider Other First Name:
CAM-TU
Provider Other Middle Name:
THI
Provider Other Name Prefix Text:
PROF.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1255318242
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/16/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12418 ROCK RIDGE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HERNDON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20170-5726
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-241-2412
Provider Business Mailing Address Fax Number:
703-241-5743

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6316 CASTLE PL
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
FALLS CHURCH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22044-1906
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-241-2412
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/29/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  0101054907 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 0101054907 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2697907 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 541999294 . This is a "UNITEDHEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 317926 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 541999294 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5846013 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: F145 . This is a "CAREFIRST BC BS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 7289333 . This is a "AETNA PPO" identifier . This identifiers is of the category "OTHER".




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