Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | D40563 | MD |
NPI | 1043248206 |
---|---|
Provider Name | Robert A Thompson JR. |
First Address | Baltimore, MD 21264-4075 |
Second Address | Baltimore, MD 21202-2102 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
083561700 | (05) | MD |
E96762 | (02) | |
KV53ST / 523341 | BC / BS OF MD (01) | MD |
S186 / 0032 | BLUECHOICE (01) | MD |