Provider Demographics
NPI:1497878979
Name:THOMPSON, ASHA MARY (DPM)
Entity Type:Individual
Prefix:DR
First Name:ASHA
Middle Name:MARY
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3311 ALEXANDER RD
Mailing Address - Street 2:
Mailing Address - City:PEMBERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43450-9618
Mailing Address - Country:US
Mailing Address - Phone:419-287-4793
Mailing Address - Fax:
Practice Address - Street 1:3311 ALEXANDER RD
Practice Address - Street 2:
Practice Address - City:PEMBERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43450-9618
Practice Address - Country:US
Practice Address - Phone:419-287-4793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003020213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2079334Medicaid
OH2079334Medicaid
OHTHO881581Medicare PIN