Healthcare Provider Details

I. General information

NPI: 1558608786
Provider Name (Legal Business Name): THOMPSON & SJAARDA, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2013
Last Update Date: 01/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9700 PATUXENT WOODS DR STE 110
COLUMBIA MD
21046-2938
US

IV. Provider business mailing address

6569 N CHARLES ST STE 605
BALTIMORE MD
21204-6833
US

V. Phone/Fax

Practice location:
  • Phone: 410-772-9700
  • Fax: 410-772-9755
Mailing address:
  • Phone: 410-296-9700
  • Fax: 410-296-9705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN TILYNN THOMPSON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 410-296-9700