Provider Demographics
NPI:1437137635
Name:THOMPSON, ELIZABETH A (PA C)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:A
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:A
Other - Last Name:MILNER-THOMPSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 858
Mailing Address - Street 2:MC A410
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-0858
Mailing Address - Country:US
Mailing Address - Phone:800-243-1455
Mailing Address - Fax:
Practice Address - Street 1:500 UNIVERSITY DR
Practice Address - Street 2:PENN STATE HERSHEY MEDICAL CENTER
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-2360
Practice Address - Country:US
Practice Address - Phone:717-531-4950
Practice Address - Fax:717-531-6770
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA002397L363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
03261702OtherCAP BLUE CROSS
PA1032847140001Medicaid
PA059302Medicare PIN