Provider Demographics
NPI:1457381832
Name:THOMPSON, DENISE K (MD)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:K
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:K
Other - Last Name:LONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:299 E PENDLETON AVE
Mailing Address - Street 2:SUITE 547
Mailing Address - City:LAPEL
Mailing Address - State:IN
Mailing Address - Zip Code:46051-5546
Mailing Address - Country:US
Mailing Address - Phone:765-534-3640
Mailing Address - Fax:765-534-3638
Practice Address - Street 1:299 E PENDLETON AVE
Practice Address - Street 2:SUITE 547
Practice Address - City:LAPEL
Practice Address - State:IN
Practice Address - Zip Code:46051-5546
Practice Address - Country:US
Practice Address - Phone:765-534-3640
Practice Address - Fax:765-534-3638
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01052980A207VG0400X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000899679OtherANTHEM
IN1326442500OtherGROUP NPI
IN200453540Medicaid
IN8963032OtherCIGNA
INH97202Medicare UPIN
IN000000899679OtherANTHEM
INDC3600OtherRAILROAD GROUP
INP00724966OtherRAILROAD INDIVIDUAL
IN250960JMedicare PIN
IN220620G5Medicare PIN