Provider Demographics
NPI:1588176184
Name:THOMPSON, CYNTHIA NOVAK (PA-C)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:NOVAK
Last Name:THOMPSON
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:681 DILL CT
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-4101
Mailing Address - Country:US
Mailing Address - Phone:667-967-6431
Mailing Address - Fax:
Practice Address - Street 1:301 ST. PAUL PLACE
Practice Address - Street 2:POB SUITE 607
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-2102
Practice Address - Country:US
Practice Address - Phone:410-332-9260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-04
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0006602363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant