Individual
S MICHELLE THORNBLADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA C
Contact information
Practice address
3975 SAINT CHARLES PKWY, WALDORF, MD 20602-2683
(301) 645-6800
(301) 645-8696
Mailing address
330 N HOWARD ST, BALTIMORE, MD 21201-3610
(410) 576-1400
(410) 576-7600
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
C0002969
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1421
LICENSE (EXPIRED)
CO
01
—
PA02088
PA LICENSE (INACTIVE STAT
TX
Enumeration date
08/02/2005
Last updated
07/08/2007
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