Provider Demographics
NPI:1457482663
Name:THOMPSON & SJAARDA PA
Entity Type:Organization
Organization Name:THOMPSON & SJAARDA PA
Other - Org Name:RETINA SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:LATHROP
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:410-296-9700
Mailing Address - Street 1:6569 N CHARLES ST
Mailing Address - Street 2:SUITE 605
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21204-6831
Mailing Address - Country:US
Mailing Address - Phone:410-296-9700
Mailing Address - Fax:410-296-9705
Practice Address - Street 1:77 THOMAS JOHNSON DR STE B
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4893
Practice Address - Country:US
Practice Address - Phone:301-682-9700
Practice Address - Fax:301-682-3578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDCD5739OtherRAILROAD MEDICARE
MDCD5739Medicare PIN
MD348MMedicare PIN