Dr Brent C Thibodeaux, MD | |
11445 Sunset Hills Rd, Kaiser Permanente Reston Medical Center, Reston, VA 20190-5276 | |
(703) 709-1500 | |
(703) 709-1711 |
Full Name | Dr Brent C Thibodeaux |
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Gender | Male |
Speciality | Pediatrics |
Location | 11445 Sunset Hills Rd, Reston, Virginia |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
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1386705721 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208000000X | Pediatrics | D61216 (Maryland) | Secondary |
208000000X | Pediatrics | MD034757 (District Of Columbia) | Secondary |
208000000X | Pediatrics | 0101057696 (Virginia) | Primary |
Entity Name | Kaiser Foundation Health Plan Of The Mid-atlantic States, Inc |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1952461816 PECOS PAC ID: 3779495858 Enrollment ID: O20040105000308 |
Mailing Address | Practice Location Address |
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Dr Brent C Thibodeaux, MD 2101 E Jefferson St, Kaiser Permanente Medicare Enrollment, Rockville, MD 20852-4908 Ph: (301) 816-2424 | Dr Brent C Thibodeaux, MD 11445 Sunset Hills Rd, Kaiser Permanente Reston Medical Center, Reston, VA 20190-5276 Ph: (703) 709-1500 |
Emily A Lozano, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 1850 Town Center Pkwy, Reston Hospital Center, Reston, VA 20190 Phone: 703-689-9037 Fax: 703-689-9109 | |
Niloofar Arbabi, MD Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 1760 Reston Pkwy, Suite 400, Reston, VA 20190 Phone: 703-467-9444 Fax: 703-467-8484 | |
Ruth Avigan Mann, M.D. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 11130 Sunrise Valley Dr, Suite #150, Reston, VA 20191 Phone: 703-262-0100 Fax: 703-262-0333 | |
Dr. Damien M Parker, M.D. Pediatrics Medicare: Medicare Enrolled Practice Location: 1890 Metro Center Dr, Reston, VA 20190 Phone: 703-709-1500 Fax: 703-709-1625 | |
Dr. Gail Carome, M.D. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 11130 Sunrise Valley Dr, Suite 150, Reston, VA 20191 Phone: 703-262-0100 Fax: 703-262-0333 | |
Geetanjali Jain, MSN, DNP, FNP-BC Pediatrics Medicare: Medicare Enrolled Practice Location: 11800 Sunrise Valley Dr Ste 700, Reston, VA 20191 Phone: 703-834-1473 Fax: 703-318-7463 | |
Dr. Mindy Stern, M.D. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 11349 Sunset Hills Rd, Reston, VA 20190 Phone: 703-327-0075 |