Provider Demographics
NPI:1790863496
Name:THOMPSON, PATTI LYNETTE (DPM)
Entity Type:Individual
Prefix:DR
First Name:PATTI
Middle Name:LYNETTE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 124
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NC
Mailing Address - Zip Code:27278-0124
Mailing Address - Country:US
Mailing Address - Phone:919-732-4860
Mailing Address - Fax:919-732-9341
Practice Address - Street 1:101 E CORBIN ST
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NC
Practice Address - Zip Code:27278-2104
Practice Address - Country:US
Practice Address - Phone:919-644-1111
Practice Address - Fax:919-644-2111
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC478213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89081AEMedicaid
NC081AEOtherBCBS
NC2430029Medicare ID - Type Unspecified
NC89081AEMedicaid