Provider Demographics
NPI:1780664813
Name:THOMPSON, TRICIA J (DO)
Entity Type:Individual
Prefix:
First Name:TRICIA
Middle Name:J
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:TRICIA
Other - Middle Name:J
Other - Last Name:HANDEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 513001
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19175-3001
Mailing Address - Country:US
Mailing Address - Phone:781-280-1694
Mailing Address - Fax:781-276-6473
Practice Address - Street 1:100 EAST CARROLL STREET
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801
Practice Address - Country:US
Practice Address - Phone:410-543-7742
Practice Address - Fax:410-546-6350
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0061165207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDI795Medicare PIN
MDS450Medicare ID - Type Unspecified
MDI795Medicare ID - Type Unspecified