Provider Demographics
NPI:1215294434
Name:THOLEN, MICHAEL RICHARD (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:RICHARD
Last Name:THOLEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7983 MILLSTREAM CT
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-6144
Mailing Address - Country:US
Mailing Address - Phone:612-850-5919
Mailing Address - Fax:
Practice Address - Street 1:5 BEL AIR SOUTH PKWY STE 1535
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015-3816
Practice Address - Country:US
Practice Address - Phone:410-569-0044
Practice Address - Fax:410-569-2331
Is Sole Proprietor?:No
Enumeration Date:2012-04-12
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0081849208D00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208600000XAllopathic & Osteopathic PhysiciansSurgery