Provider Demographics
NPI:1639564800
Name:THOMPSON, DAVID TIMOTHY (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:TIMOTHY
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 1:9905 SHELBYVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-2907
Mailing Address - Country:US
Mailing Address - Phone:502-425-5166
Mailing Address - Fax:502-327-0526
Practice Address - Street 1:7810 5 MILE RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45230-2356
Practice Address - Country:US
Practice Address - Phone:513-246-7000
Practice Address - Fax:513-246-2876
Is Sole Proprietor?:No
Enumeration Date:2015-04-03
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY51499208000000X
OH35139480208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2565399Medicaid
KY7100537840Medicaid