Provider Demographics
NPI:1093763195
Name:THOMPSON, MARK E (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:E
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 PLAZA PROPERTIES BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-1531
Mailing Address - Country:US
Mailing Address - Phone:614-383-6000
Mailing Address - Fax:614-383-6001
Practice Address - Street 1:3100 PLAZA PROPERTIES BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-1531
Practice Address - Country:US
Practice Address - Phone:614-383-6000
Practice Address - Fax:614-383-6001
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35048176207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000118597OtherANTHEM BC/BS
OH000000118597OtherANTHEM
OH0526952Medicaid
OH3000064OtherUNITED HEALTHCARE
OH000000118597OtherANTHEM BC/BS
OH000000118597OtherANTHEM