Provider Demographics
NPI:1366425753
Name:THAL, RAYMOND (MD)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
Last Name:THAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1029 FOUNDERS RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-2038
Mailing Address - Country:US
Mailing Address - Phone:703-407-6910
Mailing Address - Fax:
Practice Address - Street 1:10215 FERNWOOD RD STE 502
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-1184
Practice Address - Country:US
Practice Address - Phone:301-804-1385
Practice Address - Fax:301-897-8597
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101234751207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAE04375Medicare UPIN
DC607375T99Medicare PIN