Healthcare Provider Details

I. General information

NPI: 1710371232
Provider Name (Legal Business Name): STEPHEN THOMPSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2015
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1133 21ST ST NW STE 200
WASHINGTON DC
20036-3324
US

IV. Provider business mailing address

1133 21ST ST NW STE 200
WASHINGTON DC
20036-3324
US

V. Phone/Fax

Practice location:
  • Phone: 202-331-1740
  • Fax:
Mailing address:
  • Phone: 202-331-1740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberD0087185
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number0101266631
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD047219
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: