Provider Demographics
NPI:1659993459
Name:THOMPSON, MATT (MA MBBS MD FRCS)
Entity Type:Individual
Prefix:DR
First Name:MATT
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:MA MBBS MD FRCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 EPISODE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-1379
Mailing Address - Country:US
Mailing Address - Phone:949-468-8454
Mailing Address - Fax:
Practice Address - Street 1:DEPARTMENT OF VASCULAR SURGERY 9500 EUCLID AVENUE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:216-444-3581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-14
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH75.0000282086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery