Provider Demographics
NPI:1487650289
Name:THOMPSON, ANGELA J (PA)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:J
Last Name:THOMPSON
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Gender:F
Credentials:PA
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Mailing Address - Street 1:5900 LAKE WRIGHT DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-1871
Mailing Address - Country:US
Mailing Address - Phone:757-213-5700
Mailing Address - Fax:757-213-5701
Practice Address - Street 1:150 BURNETTS WAY
Practice Address - Street 2:SUITE 310
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-8177
Practice Address - Country:US
Practice Address - Phone:757-539-0670
Practice Address - Fax:757-539-1062
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2008-04-14
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Provider Licenses
StateLicense IDTaxonomies
VA0110001581363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009197V25Medicare PIN
VAQ58290Medicare UPIN