Provider Demographics
NPI:1215013255
Name:REDFEARN-THOMPSON, JOAN (MD)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:REDFEARN-THOMPSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6196 OXON HILL RD.
Mailing Address - Street 2:SUITE 610
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745-3112
Mailing Address - Country:US
Mailing Address - Phone:301-839-5804
Mailing Address - Fax:301-839-6882
Practice Address - Street 1:6196 OXON HILL RD.
Practice Address - Street 2:SUITE 610
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-3112
Practice Address - Country:US
Practice Address - Phone:301-839-5804
Practice Address - Fax:301-839-6882
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0035456207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
107639R95Medicare ID - Type Unspecified
MDC57390Medicare UPIN