Provider Demographics
NPI:1437125150
Name:THOMPSON, JOHN M (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:M
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 601888
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1888
Mailing Address - Country:US
Mailing Address - Phone:704-289-2553
Mailing Address - Fax:704-289-6496
Practice Address - Street 1:1550 FAULK ST
Practice Address - Street 2:SUITE 2100
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-5086
Practice Address - Country:US
Practice Address - Phone:704-289-2553
Practice Address - Fax:704-289-6496
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-06-7454T207V00000X
NC2006-01280207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCN01281Medicaid
OH0993037Medicaid
NC1437125150Medicaid
NC5905276Medicaid
NCNC9506AMedicare PIN
NC1437125150Medicaid
OHTH4134361Medicare PIN
NC2062510Medicare PIN