MEDICARE: MR. BARRY EUGENE THOMPSON PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	C0001323	MD
2	363A00000X	Physician Assistant	C01323	MD

General Provider Information

NPI Number	:	1083686794
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BARRY EUGENE THOMPSON PA-C

Provider Business Mailing Address
First Line	:	12200 ANNAPOLIS RD STE 123
Second Line	:
City	:	GLENN DALE
State	:	MD
Zip	:	20769-9182
Country	:	US
Telephone Number	:	301-364-9292
Fax Number	:	301-552-9743

Provider Business Practice Location Address
First Line	:	12200 ANNAPOLIS RD STE 123
Second Line	:
City	:	GLENN DALE
State	:	MD
Zip	:	20769-9182
Country	:	US
Telephone Number	:	301-364-9292
Fax Number	:	301-552-9743

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2006
Last Update Date	:	09/21/2020

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Directions to “ MR. BARRY EUGENE THOMPSON PA-C” Practice Location

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