Healthcare Provider Details

I. General information

NPI: 1114083052
Provider Name (Legal Business Name): JAY THOMPSON RORICK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 BESTGATE ROAD SUITE 102
ANNAPOLIS MD
21401-3091
US

IV. Provider business mailing address

2101 EAST JEFFERSON STREET PPQA MEDICARE COMPLIANCE UNIT 6 WEST
ROCKVILLE MD
20852-4918
US

V. Phone/Fax

Practice location:
  • Phone: 410-571-7325
  • Fax: 410-571-7301
Mailing address:
  • Phone: 301-816-6660
  • Fax: 301-816-6308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License NumberD33186
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: