Provider Demographics
NPI:1093781577
Name:THOMPSON, ROBERT SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:SCOTT
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:R.
Other - Middle Name:SCOTT
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:498 WANDO PARK BLVD STE 500
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-7963
Mailing Address - Country:US
Mailing Address - Phone:843-216-8139
Mailing Address - Fax:866-834-5680
Practice Address - Street 1:498 WANDO PARK BLVD STE 500
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-7963
Practice Address - Country:US
Practice Address - Phone:843-216-8139
Practice Address - Fax:866-834-5680
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17322207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC110241772OtherRR MEDICARE
SC110241772OtherRR MEDICARE
SCT12288Medicaid