Healthcare Provider Details

I. General information

NPI: 1124447685
Provider Name (Legal Business Name): MARISA GILSTROP THOMPSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2014
Last Update Date: 01/02/2024
Certification Date: 01/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CENTURIAN DR STE 312
NEWARK DE
19713-2127
US

IV. Provider business mailing address

1 CENTURIAN DR STE 312
NEWARK DE
19713-2127
US

V. Phone/Fax

Practice location:
  • Phone: 302-319-5680
  • Fax: 302-319-5681
Mailing address:
  • Phone: 302-319-5680
  • Fax: 302-319-5681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberD84948
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberC1-0025093
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: