Provider Demographics
NPI:1356857502
Name:THOMPSON, PAMELA DENISE (PHD)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:DENISE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:276 LAKE ROYALE
Mailing Address - Street 2:
Mailing Address - City:LOUISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:27549-9517
Mailing Address - Country:US
Mailing Address - Phone:919-376-5948
Mailing Address - Fax:
Practice Address - Street 1:4400 OLD POOLE RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-3033
Practice Address - Country:US
Practice Address - Phone:919-376-5948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-26
Last Update Date:2017-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2472B0301X, 1744R1102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744R1102XOther Service ProvidersSpecialistResearch StudyGroup - Multi-Specialty
No2472B0301XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherBiomedical EngineeringGroup - Multi-Specialty