Provider Demographics
NPI:1295460947
Name:THOMPSON, MARIA
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:537 BROAD HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25704-9525
Mailing Address - Country:US
Mailing Address - Phone:304-730-3015
Mailing Address - Fax:
Practice Address - Street 1:802 OAK ST
Practice Address - Street 2:
Practice Address - City:KENOVA
Practice Address - State:WV
Practice Address - Zip Code:25530-1519
Practice Address - Country:US
Practice Address - Phone:304-908-1056
Practice Address - Fax:304-400-6620
Is Sole Proprietor?:No
Enumeration Date:2022-07-18
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist