Provider Demographics
NPI: | 1376501304 |
---|---|
Name: | THOMPSON, ROHAN ANTHONY (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | ROHAN |
Middle Name: | ANTHONY |
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 1026 |
Mailing Address - Street 2: | |
Mailing Address - City: | INDIANAPOLIS |
Mailing Address - State: | IN |
Mailing Address - Zip Code: | 46206-1026 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 317-777-6435 |
Mailing Address - Fax: | 317-777-6644 |
Practice Address - Street 1: | 705 RILEY HOSPITAL DR |
Practice Address - Street 2: | |
Practice Address - City: | INDIANAPOLIS |
Practice Address - State: | IN |
Practice Address - Zip Code: | 46202-5109 |
Practice Address - Country: | US |
Practice Address - Phone: | 317-948-7208 |
Practice Address - Fax: | 317-944-7245 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-05-01 |
Last Update Date: | 2022-01-11 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
IN | 01086966A | 2080P0214X, 2080S0012X, 2080P0214X, 2080S0012X |
OH | 350876671 | 2080S0012X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 2080S0012X | Allopathic & Osteopathic Physicians | Pediatrics | Sleep Medicine |
No | 2080P0214X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Pulmonology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
IN | 300035643 | Medicaid |