MEDICARE: DR. DWAYNE THOMPSON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	D0059232	MD

General Provider Information

NPI Number	:	1386630614
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DWAYNE THOMPSON M.D.

Provider Business Mailing Address
First Line	:	1221 MERCANTILE LN
Second Line	:
City	:	LARGO
State	:	MD
Zip	:	20774-5374
Country	:	US
Telephone Number	:	301-386-6000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1221 MERCANTILE LN
Second Line	:
City	:	LARGO
State	:	MD
Zip	:	20774-5374
Country	:	US
Telephone Number	:	301-386-6000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2005
Last Update Date	:	12/08/2021

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