Theresa Elaine Bourne, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

D86548 Issued in MD

Practice address

8821 Columbia 100 Pkwy
Columbia, MD 21045-2274

Phone

(410) 997-1700

Fax

(410) 740-8315

NPI assigned

Apr 20, 2016

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Theresa Elaine Neiderer Former name

Medicare fee-for-service enrollment

Enrolled in MD

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Hello Pediatrics Medical Group PLLC

  • Pediatrics Physician
  • Fairfax, VA
  • NPI 1447964846
  NPD (past)
• Trusted Doctors LLC

  • Pediatrics Physician
  • Fairfax, VA
  • NPI 1083793525
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1461110400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1561852800000",
    "number": "1972957512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8821 COLUMBIA 100 PKWY",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210452274",
            "telephone_number": "410-997-1700",
            "fax_number": "410-740-8315"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8821 COLUMBIA 100 PKWY",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210452274",
            "telephone_number": "410-997-1700",
            "fax_number": "410-740-8315"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOURNE",
        "first_name": "THERESA",
        "middle_name": "ELAINE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-04-20",
        "last_updated": "2019-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MD",
            "license": "D86548",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "THERESA",
            "last_name": "NEIDERER",
            "middle_name": "ELAINE",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Bobbi Hitchcock Boteler, R.D.
• Ellen Florence Boudreau, M.D.
• Elana Patrice Bouldin, LCSW-C
• Bounce Back Physical Therapy LLC
• Mariah Tamia Bourgouis
• Efstratios Bouyouks, PHARMD
• Krystle Hanna Bove, AU.D.
• Julia Marie Bowden
• Gloria Bowen, LCSW-C, LICSW
• La'Vante Bowen

• Pediatrics Physician in Columbia, MD
• Providers in Columbia, MD by specialty
• Pediatrics Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.