Provider Demographics
NPI:1942251855
Name:THOMPSON, MATTHEW (DPM)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1738 METROMEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3861
Mailing Address - Country:US
Mailing Address - Phone:910-484-4191
Mailing Address - Fax:910-484-5546
Practice Address - Street 1:4850 FAYETTEVILLE RD
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2100
Practice Address - Country:US
Practice Address - Phone:910-738-4811
Practice Address - Fax:910-738-7212
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC158213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC08195OtherBCBS
NC8908195Medicaid
NC08195OtherBCBS
NC243077DMedicare ID - Type Unspecified