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NPI Code Detail

MEDICARE: KISTACIA THOMPSON MD

MEDICARE: KISTACIA THOMPSON MD
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1124962386
Entity Type Code : Individual
Provider Name (Legal Business Name) : KISTACIA THOMPSON MD
Provider Business Mailing Address
First Line : 901 HARRY S TRUMAN DR N
Second Line :
City : LARGO
State : MD
Zip : 20774-5477
Country : US
Telephone Number : 240-677-0021
Fax Number :
Provider Business Practice Location Address
First Line : 4000 GARDEN CITY DR STE 810
Second Line :
City : HYATTSVILLE
State : MD
Zip : 20785-2419
Country : US
Telephone Number : 240-677-3100
Fax Number : 301-851-5600
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/17/2026
Last Update Date : 04/17/2026

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Directions to “ KISTACIA THOMPSON MD” Practice Location

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