Healthcare Provider Details

I. General information

NPI: 1821042748
Provider Name (Legal Business Name): EDWARD THOMPSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 11/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 9TH AVE
BRUNSWICK MD
21716-1828
US

IV. Provider business mailing address

1434 PORTER ST
FREDERICK MD
21702-9254
US

V. Phone/Fax

Practice location:
  • Phone: 301-834-7188
  • Fax: 301-834-7889
Mailing address:
  • Phone: 301-619-2206
  • Fax: 301-619-4989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberD0029262
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD29262
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: