Provider Demographics
NPI:1053679555
Name:THOMPSON, ELIZABETH LEET (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:LEET
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8821 COLUMBIA 100 PARKWAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045
Mailing Address - Country:US
Mailing Address - Phone:410-997-6400
Mailing Address - Fax:410-730-6198
Practice Address - Street 1:8821 COLUMBIA 100 PARKWAY
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045
Practice Address - Country:US
Practice Address - Phone:410-997-6400
Practice Address - Fax:410-730-6198
Is Sole Proprietor?:No
Enumeration Date:2012-05-03
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MDD0079485208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD7450451-00Medicaid