Provider Demographics
NPI:1174572523
Name:THOMPSON, JOHN R III (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:THOMPSON
Suffix:III
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:BOX 230
Mailing Address - Street 2:800 E ROCHAMBEAU DR STE F
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-9006
Mailing Address - Country:US
Mailing Address - Phone:757-656-2295
Mailing Address - Fax:757-210-3108
Practice Address - Street 1:800 E ROCHAMBEAU DR STE F230
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-9006
Practice Address - Country:US
Practice Address - Phone:757-656-2295
Practice Address - Fax:757-210-3108
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ15609207QA0401X
VA0101279714207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01023481Medicaid
NY01023481Medicaid
NYBA0502Medicare ID - Type Unspecified