Provider Demographics
NPI:1336107770
Name:THOMPSON, TERRY (MD)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:
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:PO BOX 11646
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24506-1646
Mailing Address - Country:US
Mailing Address - Phone:434-200-5895
Mailing Address - Fax:434-200-7529
Practice Address - Street 1:1901 TATE SPRINGS RD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-1109
Practice Address - Country:US
Practice Address - Phone:434-200-5895
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101234752207Q00000X, 208M00000X
KS0447995207Q00000X, 208M00000X
CODR.0062929208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
188804OtherANTHEM
6967829OtherCIGNA HEALTH CARE
423488OtherSOUTHERN HEALTH
VA010244722Medicaid
VA010256674Medicaid
012816C39Medicare PIN
I07012Medicare UPIN
VA021962M68Medicare PIN
VA022509C59Medicare PIN
423488OtherSOUTHERN HEALTH
188804OtherANTHEM
VA010244722Medicaid