Provider Demographics
NPI:1023015476
Name:THOMPSON, WILLIAM MCKINLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:MCKINLEY
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1960 ELECTRIC RD
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-1621
Mailing Address - Country:US
Mailing Address - Phone:540-772-7171
Mailing Address - Fax:540-774-8299
Practice Address - Street 1:1960 ELECTRIC RD
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-1621
Practice Address - Country:US
Practice Address - Phone:540-772-7171
Practice Address - Fax:540-774-8299
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101227709207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6311164Medicaid
VA001934E75Medicare ID - Type Unspecified
VA6311164Medicaid