Provider Demographics
NPI:1558331033
Name:THOMPSON, DAVID E (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:E
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 1:999 EXECUTIVE PARK BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-4632
Mailing Address - Country:US
Mailing Address - Phone:423-224-3250
Mailing Address - Fax:423-224-3258
Practice Address - Street 1:1 MEDICAL PARK BLVD
Practice Address - Street 2:SUITE 200 EAST
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-7430
Practice Address - Country:US
Practice Address - Phone:423-844-5100
Practice Address - Fax:423-844-5109
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN19307207R00000X
VA0101044245207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3043536Medicaid
TN3043530Medicare PIN
VAV V5996AMedicare PIN
D93183Medicare UPIN
TN3043536Medicaid
TN110120207Medicare PIN
VA002379W21Medicare PIN