Healthcare Provider Details

I. General information

NPI: 1003323478
Provider Name (Legal Business Name): PATRICK THOMPSON LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2018
Last Update Date: 01/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 SOLAREX CT
FREDERICK MD
21703-7005
US

IV. Provider business mailing address

9009 GRAPE CREEK RD
WALKERSVILLE MD
21793-8808
US

V. Phone/Fax

Practice location:
  • Phone: 301-305-2321
  • Fax:
Mailing address:
  • Phone: 301-305-2321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberU02458
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: