Provider Demographics
NPI:1497746663
Name:THOMPSON, TERENCE (MD)
Entity Type:Individual
Prefix:DR
First Name:TERENCE
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8833 RESEDA BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-5353
Mailing Address - Country:US
Mailing Address - Phone:818-341-0670
Mailing Address - Fax:818-341-0690
Practice Address - Street 1:8833 RESEDA BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-5353
Practice Address - Country:US
Practice Address - Phone:818-341-0670
Practice Address - Fax:818-341-0690
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA55500207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG56331Medicare UPIN
CAA55500Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID NO