Provider Demographics
NPI:1114962172
Name:THOMPSON, ANA MARIE (MD)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:MARIE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4126 N HOLLAND SYLVANIA RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-2504
Mailing Address - Country:US
Mailing Address - Phone:417-473-3257
Mailing Address - Fax:419-473-8816
Practice Address - Street 1:4126 N HOLLAND SYLVANIA RD
Practice Address - Street 2:SUITE 200
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-2504
Practice Address - Country:US
Practice Address - Phone:417-473-3257
Practice Address - Fax:419-473-8816
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35081395T207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00102183OtherMEDICARE RAILROAD
OH2465363Medicaid
OH4130471Medicare PIN
OH9930481Medicare PIN
OHH36440Medicare UPIN