Provider Demographics
NPI:1477118859
Name:THOMPSON, DALIA M
Entity Type:Individual
Prefix:
First Name:DALIA
Middle Name:M
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DALIA
Other - Middle Name:M
Other - Last Name:GREGORY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:237 LIBBY ST
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23663-2256
Mailing Address - Country:US
Mailing Address - Phone:609-346-1906
Mailing Address - Fax:
Practice Address - Street 1:237 LIBBY ST
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23663-2256
Practice Address - Country:US
Practice Address - Phone:609-346-1906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-01
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA131887OtherCITY OF HAMPTON