Provider Demographics
NPI:1598790586
Name:THOMPSON, HERMAN ORA JR (MD)
Entity Type:Individual
Prefix:DR
First Name:HERMAN
Middle Name:ORA
Last Name:THOMPSON
Suffix:JR
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 1:1730 HENDERSON ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201
Mailing Address - Country:US
Mailing Address - Phone:803-765-2600
Mailing Address - Fax:803-799-6434
Practice Address - Street 1:1730 HENDERSON ST
Practice Address - Street 2:SUITE C
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201
Practice Address - Country:US
Practice Address - Phone:803-765-2600
Practice Address - Fax:803-799-6434
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9101207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0300320OtherCCP
SCTL 9856Medicaid
0300320OtherCCP