Healthcare Provider Details

I. General information

NPI: 1457457939
Provider Name (Legal Business Name): JEFFREY THOMPSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 UPPER CHESAPEAKE DR
BEL AIR MD
21014-4324
US

IV. Provider business mailing address

PO BOX 827435
PHILADELPHIA PA
19182-7435
US

V. Phone/Fax

Practice location:
  • Phone: 443-643-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0000X
TaxonomyAdolescent Medicine (Internal Medicine) Physician
License NumberD0053568
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: