Provider Demographics
NPI:1841358462
Name:THOMPSON, CAREN LEE (MD)
Entity type:Individual
Prefix:
First Name:CAREN
Middle Name:LEE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 BAYNARD BLVD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19802-3900
Mailing Address - Country:US
Mailing Address - Phone:302-777-5060
Mailing Address - Fax:302-777-0422
Practice Address - Street 1:2100 BAYNARD BLVD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19802-3900
Practice Address - Country:US
Practice Address - Phone:302-777-5060
Practice Address - Fax:302-777-0422
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10003417208D00000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEF37617Medicare UPIN