Provider Demographics
NPI:1548238272
Name:THOMPSON, MELISSA D (MD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:D
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4371 NARROW LANE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36116-2971
Mailing Address - Country:US
Mailing Address - Phone:334-613-3680
Mailing Address - Fax:334-613-3685
Practice Address - Street 1:4371 NARROW LANE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116-2971
Practice Address - Country:US
Practice Address - Phone:334-613-3680
Practice Address - Fax:334-613-3685
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL21288207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL080157843OtherRR MEDICARE
AL051055410OtherBC BS OF ALABAMA
AL009934280Medicaid
051055410OtherBLUE CROSS BLUE SHIELD
AL000055410OtherMEDICARE PROVIDER
051055410OtherBLUE CROSS BLUE SHIELD
G69941Medicare UPIN