Healthcare Provider Details

I. General information

NPI: 1487016119
Provider Name (Legal Business Name): CHELSEA HAYES THOMPSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHELSEA LYNN HAYES MD

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 MITCHELLS CHANCE RD STE 180
EDGEWATER MD
21037-2793
US

IV. Provider business mailing address

6201 GREENLEIGH AVE
MIDDLE RIVER MD
21220-2004
US

V. Phone/Fax

Practice location:
  • Phone: 410-224-8220
  • Fax: 410-367-2118
Mailing address:
  • Phone: 410-933-5412
  • Fax: 410-367-2118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101262992
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0101262992
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD0097077
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: