Provider Demographics
NPI:1477521136
Name:THOMPSON, KATHERINE C (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:C
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3574 SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-3044
Mailing Address - Country:US
Mailing Address - Phone:803-796-2500
Mailing Address - Fax:803-796-4378
Practice Address - Street 1:3574 SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-3044
Practice Address - Country:US
Practice Address - Phone:803-796-2500
Practice Address - Fax:803-796-4378
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC15834207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0302087OtherCAROLINA CARE PLAN
SCPA1426Medicaid
SCF22877Medicare UPIN
SCF228771786Medicare ID - Type Unspecified