Provider Demographics
NPI:1992005771
Name:THOMPSON, WILLIE EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIE
Middle Name:EDWARD
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 1:10814 CHERRY BLOSSOM CT
Mailing Address - Street 2:
Mailing Address - City:ADELPHI
Mailing Address - State:MD
Mailing Address - Zip Code:20783-1043
Mailing Address - Country:US
Mailing Address - Phone:301-937-7525
Mailing Address - Fax:301-937-0656
Practice Address - Street 1:10814 CHERRY BLOSSOM CT
Practice Address - Street 2:
Practice Address - City:ADELPHI
Practice Address - State:MD
Practice Address - Zip Code:20783-1043
Practice Address - Country:US
Practice Address - Phone:301-937-7525
Practice Address - Fax:301-937-0656
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-27
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD34030174400000X
DC15132174400000X
PAMD423157174400000X
DEC1-0006664174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist