Provider Demographics
NPI:1619928371
Name:THOMPSON, IAN MARTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:IAN
Middle Name:MARTIN
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 1:140 W MAIN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45502-1312
Mailing Address - Country:US
Mailing Address - Phone:937-398-1066
Mailing Address - Fax:937-398-1076
Practice Address - Street 1:140 W MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45502-1312
Practice Address - Country:US
Practice Address - Phone:937-398-1066
Practice Address - Fax:937-398-1076
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-085484207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2587615Medicaid
7263710OtherAETNA
OH10636333OtherCAQH
368457OtherANTHEM
OH4161981Medicare PIN
OHSP 9354821Medicare PIN
OH10636333OtherCAQH
OH2587615Medicaid