Provider Demographics
NPI:1396801239
Name:THOMPSON, GLYNN M (MD)
Entity type:Individual
Prefix:DR
First Name:GLYNN
Middle Name:M
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2101 EAST JEFFERSON STREET
Mailing Address - Street 2:PPQA MEDICARE COMPLIANCE UNIT 6 WEST KAISER PERMANENTE
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4908
Mailing Address - Country:US
Mailing Address - Phone:301-816-6660
Mailing Address - Fax:301-816-6308
Practice Address - Street 1:655 WATKINS MILL RD
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-3301
Practice Address - Country:US
Practice Address - Phone:240-632-4500
Practice Address - Fax:240-632-4501
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2021-06-04
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Provider Licenses
StateLicense IDTaxonomies
MDD0041777207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
717037M92Medicare ID - Type Unspecified
F24059Medicare UPIN