Provider Demographics
NPI:1588620652
Name:THOMPSON, JAMES W (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:W
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 1:346 OVERLOOK LN
Mailing Address - Street 2:
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-2634
Mailing Address - Country:US
Mailing Address - Phone:610-567-0077
Mailing Address - Fax:610-567-0077
Practice Address - Street 1:346 OVERLOOK LN
Practice Address - Street 2:
Practice Address - City:CONSHOHOCKEN
Practice Address - State:PA
Practice Address - Zip Code:19428-2634
Practice Address - Country:US
Practice Address - Phone:610-567-0077
Practice Address - Fax:610-567-0077
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAD70928174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA5776OtherAETNA
PA0045558000OtherKEYSTONE HEALTH PLAN
PA006704380001Medicaid
PA17545OtherBLUE SHIELD
PA006704380001Medicaid
PA17545Medicare ID - Type Unspecified