Provider Demographics
NPI:1043604044
Name:THOMPSON, AMANDA M (MD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:M
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:AMANDA
Other - Middle Name:M
Other - Last Name:BANA FERNANDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:711 W 40TH ST STE 438
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21211-2199
Mailing Address - Country:US
Mailing Address - Phone:410-328-6662
Mailing Address - Fax:
Practice Address - Street 1:711 W 40TH ST STE 438
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21211-2199
Practice Address - Country:US
Practice Address - Phone:410-243-8632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-27
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0085942208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics