Provider Demographics
NPI:1487659967
Name:THOMPSON, DIANNE B (MD)
Entity Type:Individual
Prefix:
First Name:DIANNE
Middle Name:B
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 1:1229 MADISON ST
Mailing Address - Street 2:STE 1290
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-3568
Mailing Address - Country:US
Mailing Address - Phone:206-315-4603
Mailing Address - Fax:206-315-4601
Practice Address - Street 1:1229 MADISON ST
Practice Address - Street 2:STE 1290
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-3568
Practice Address - Country:US
Practice Address - Phone:206-315-4603
Practice Address - Fax:206-315-4601
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00030950207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG31579Medicare UPIN
WA8802750Medicare PIN