Healthcare Provider Details

I. General information

NPI: 1457482663
Provider Name (Legal Business Name): THOMPSON & SJAARDA PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 02/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 THOMAS JOHNSON DR STE B
FREDERICK MD
21702-4893
US

IV. Provider business mailing address

6569 N CHARLES ST SUITE 605
BALTIMORE MD
21204-6831
US

V. Phone/Fax

Practice location:
  • Phone: 301-682-9700
  • Fax: 301-682-3578
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: MR. JOHN LATHROP DAVIS JR.
Title or Position: BUSINESS MANAGER
Credential:
Phone: 410-296-9700