Provider Demographics
NPI:1518398163
Name:THOMPSON, CHARLES FREDERICK JR (MD)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:FREDERICK
Last Name:THOMPSON
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:3807 WILHELM RD
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18015-5935
Mailing Address - Country:US
Mailing Address - Phone:610-838-6145
Mailing Address - Fax:610-838-6145
Practice Address - Street 1:3807 WILHELM RD
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18015-5935
Practice Address - Country:US
Practice Address - Phone:610-838-6145
Practice Address - Fax:610-838-6145
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-09
Last Update Date:2013-12-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD-008186E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D68645Medicare UPIN