Provider Demographics
NPI:1770064503
Name:THOMPSON, HALEY MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:MARIE
Last Name:THOMPSON
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:HALEY
Other - Middle Name:MARIE
Other - Last Name:SQUIRES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:23000 MOAKLEY ST STE 102
Mailing Address - Street 2:
Mailing Address - City:LEONARDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20650-2916
Mailing Address - Country:US
Mailing Address - Phone:301-475-5555
Mailing Address - Fax:301-475-5914
Practice Address - Street 1:23000 MOAKLEY ST STE 102
Practice Address - Street 2:
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650-2916
Practice Address - Country:US
Practice Address - Phone:301-475-5555
Practice Address - Fax:301-475-5914
Is Sole Proprietor?:No
Enumeration Date:2018-08-29
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC08530363A00000X
MDC0008530363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty