Provider Demographics
NPI:1275507634
Name:THOMPSON, SHELLY L (MD)
Entity Type:Individual
Prefix:DR
First Name:SHELLY
Middle Name:L
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 N EWING ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130
Mailing Address - Country:US
Mailing Address - Phone:740-689-6699
Mailing Address - Fax:740-689-2084
Practice Address - Street 1:135 N EWING ST
Practice Address - Street 2:SUITE 205
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130
Practice Address - Country:US
Practice Address - Phone:740-689-6699
Practice Address - Fax:740-689-2084
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35064810207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0145364Medicaid
OH0781643Medicare ID - Type Unspecified
OHG02377Medicare UPIN