Provider Demographics
NPI:1548541329
Name:DANG, MAI-THU THI
Entity type:Individual
Prefix:MS
First Name:MAI-THU
Middle Name:THI
Last Name:DANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20908 FREDERICK ROAD
Mailing Address - Street 2:20601 BOLAND FARM ROAD
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20876
Mailing Address - Country:US
Mailing Address - Phone:301-515-0798
Mailing Address - Fax:301-515-0189
Practice Address - Street 1:20908 FREDERICK RD
Practice Address - Street 2:20601 BOLAND FARM ROAD
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20876-4134
Practice Address - Country:US
Practice Address - Phone:301-515-0798
Practice Address - Fax:301-515-0189
Is Sole Proprietor?:No
Enumeration Date:2011-09-07
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12212183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist