Healthcare Provider Details

I. General information

NPI: 1053679555
Provider Name (Legal Business Name): ELIZABETH LEET THOMPSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2012
Last Update Date: 08/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8821 COLUMBIA 100 PARKWAY
COLUMBIA MD
21045
US

IV. Provider business mailing address

8821 COLUMBIA 100 PARKWAY
COLUMBIA MD
21045
US

V. Phone/Fax

Practice location:
  • Phone: 410-997-6400
  • Fax: 410-730-6198
Mailing address:
  • Phone: 410-997-6400
  • Fax: 410-730-6198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0079485
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: