Provider Demographics
NPI:1053570861
Name:JUSTICE TAYLOR-TYREE, MICHELE DIANNE (MD)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:DIANNE
Last Name:JUSTICE TAYLOR-TYREE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:DIANE
Other - Last Name:JUSTICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:8110 MAPLE LAWN BLVD STE 235
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MD
Mailing Address - Zip Code:20759-2694
Mailing Address - Country:US
Mailing Address - Phone:301-340-8339
Mailing Address - Fax:301-340-9027
Practice Address - Street 1:19450 DEERFIELD AVE STE 460
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-6840
Practice Address - Country:US
Practice Address - Phone:571-707-8522
Practice Address - Fax:571-707-8577
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD49294207V00000X
VA0101251837207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology