Provider Demographics
NPI:1649556218
Name:THOMPSON, MEGAN MARIE (PAC)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:MARIE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:MARIE
Other - Last Name:TALBOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 449
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-0449
Mailing Address - Country:US
Mailing Address - Phone:740-374-4500
Mailing Address - Fax:740-374-5887
Practice Address - Street 1:800 PIKE ST STE 2
Practice Address - Street 2:EXPRESS CARE MARIETTA
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-3507
Practice Address - Country:US
Practice Address - Phone:740-373-3960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-27
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV552363A00000X
OH50.003453363A00000X
OH50.003453RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH063620Medicare PIN
OHH063621Medicare PIN