Provider Demographics
NPI:1649496209
Name:THOMPSON, LEVESTER (MD)
Entity type:Individual
Prefix:DR
First Name:LEVESTER
Middle Name:
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:PO BOX 729
Mailing Address - Street 2:
Mailing Address - City:SALTVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24370-0729
Mailing Address - Country:US
Mailing Address - Phone:276-669-5179
Mailing Address - Fax:276-466-8870
Practice Address - Street 1:2195 EUCLID AVE STE 6
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24201-3655
Practice Address - Country:US
Practice Address - Phone:276-669-5179
Practice Address - Fax:276-466-8870
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101035947208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ004502Medicaid
VAVV9479BMedicare PIN