Provider Demographics
NPI:1255373486
Name:THOMPSON, CAREN LEE (DO)
Entity type:Individual
Prefix:DR
First Name:CAREN
Middle Name:LEE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 ROBERT E LEE AVE
Mailing Address - Street 2:
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-3211
Mailing Address - Country:US
Mailing Address - Phone:304-637-8907
Mailing Address - Fax:304-637-3592
Practice Address - Street 1:630 ROBERT E LEE AVE
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-3211
Practice Address - Country:US
Practice Address - Phone:304-637-8907
Practice Address - Fax:304-637-3592
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1917207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV55885OtherUNICARE
WVP00114057OtherRAILROAD MEDICARE
WV227747OtherCARELINK
WV1063155OtherWORKERS COMPENSATIONS
WV1809691000Medicaid
WV1809691000Medicaid
WV4114561Medicare PIN