Provider Demographics
NPI:1619190691
Name:THOMPSON, TERESA (CFM)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:CFM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 SAINT MARY AVE NW
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-4528
Mailing Address - Country:US
Mailing Address - Phone:704-262-3826
Mailing Address - Fax:
Practice Address - Street 1:1025 CONCORD PKWY N
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-5923
Practice Address - Country:US
Practice Address - Phone:704-782-0908
Practice Address - Fax:704-786-0469
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7701423Medicaid
NC7795022Medicaid
NC7795022Medicaid