Provider Demographics
NPI:1407051709
Name:THOMPSON DZIRASA, LETITIA KATHLENE (MD)
Entity Type:Individual
Prefix:
First Name:LETITIA
Middle Name:KATHLENE
Last Name:THOMPSON DZIRASA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LETITIA
Other - Middle Name:KATHLENE
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3501 SINCLAIR LN
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21213-2029
Mailing Address - Country:US
Mailing Address - Phone:410-732-8800
Mailing Address - Fax:410-534-2392
Practice Address - Street 1:1245 EASTERN BLVD
Practice Address - Street 2:
Practice Address - City:ESSEX
Practice Address - State:MD
Practice Address - Zip Code:21221-3422
Practice Address - Country:US
Practice Address - Phone:410-558-4700
Practice Address - Fax:410-780-0364
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22176208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics