Provider Demographics
NPI:1023060027
Name:WEIBEL, THAIS DORRYNNE (MD)
Entity type:Individual
Prefix:DR
First Name:THAIS
Middle Name:DORRYNNE
Last Name:WEIBEL
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 1:4509 ROSEDALE AVE
Mailing Address - Street 2:
Mailing Address - City:BETHSEDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814
Mailing Address - Country:US
Mailing Address - Phone:410-997-1928
Mailing Address - Fax:410-997-1929
Practice Address - Street 1:11055 LITTLE PATUXENT PKWY
Practice Address - Street 2:SUITE 109
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044
Practice Address - Country:US
Practice Address - Phone:410-977-1928
Practice Address - Fax:410-977-1929
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00576452084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0500911Medicaid
MD0500911Medicaid
MD694M191FMedicare PIN