Alisa Thavikulwat

NPI #1265827745 in Glenn Dale, Maryland

Provider Information

NPI Number: 1265827745
Entity Type: Individual
Name: Alisa Thavikulwat
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Ophthalmology
Enumeration Date: Apr 1, 2015
Last Updated: Sep 24, 2020

Practice Location

Address: 12150 ANNAPOLIS RD STE 111
City: Glenn Dale
State: Maryland
ZIP Code: 20769-9183
Phone: (301) 779-0844

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Ophthalmology	207W00000X	Primary

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