Provider Demographics
NPI:1396724571
Name:THOMPSON, CHARLES STUART (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:STUART
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 1:80 W MICHIGAN ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-4453
Mailing Address - Country:US
Mailing Address - Phone:407-648-4323
Mailing Address - Fax:407-839-1493
Practice Address - Street 1:80 W MICHIGAN ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-4453
Practice Address - Country:US
Practice Address - Phone:407-648-4323
Practice Address - Fax:407-839-1493
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME767252086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL202773OtherWELLCARE ID NUMBER
FL7226235OtherAETNA PPO ID NUMBER
FL2811203OtherAETNA HMO ID NUMBER
FL44471OtherBC/BS OF FL ID NUMBER
FL1100121OtherGHI ID NUMBER
FL254972700Medicaid
FL770003148OtherRAILROAD MEDICARE ID NUMB
FL3365373OtherCIGNA ID NUMBER
FL259385OtherAVMED ID NUMBER
FLF83550Medicare UPIN
FL3365373OtherCIGNA ID NUMBER
FLE1024WMedicare ID - Type UnspecifiedMEDICARE ID #