Provider Demographics
NPI:1669427878
Name:THOMPSON, WILLIAM O (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:O
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 1:430 STONYCREEK ST
Mailing Address - Street 2:
Mailing Address - City:BOSWELL
Mailing Address - State:PA
Mailing Address - Zip Code:15531-1024
Mailing Address - Country:US
Mailing Address - Phone:814-893-5558
Mailing Address - Fax:814-893-5989
Practice Address - Street 1:136 PINESTREET
Practice Address - Street 2:BOX 340
Practice Address - City:STOYSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15563
Practice Address - Country:US
Practice Address - Phone:814-893-5568
Practice Address - Fax:814-893-5989
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD041994E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007698380001Medicaid
PA1007698380002Medicaid
PA069206Medicare PIN
PA393821Medicare PIN
PA393820Medicare PIN
PAE55672Medicare UPIN
PA1007698380001Medicaid