Provider Demographics
NPI:1912952953
Name:THOMPSON, HOLLY JEAN (MD)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:JEAN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:620 HOWARD AVE
Mailing Address - Street 2:ALTOONA REGIONAL HEALTH SYSTEM
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601-4899
Mailing Address - Country:US
Mailing Address - Phone:814-889-2866
Mailing Address - Fax:814-889-6785
Practice Address - Street 1:620 HOWARD AVE
Practice Address - Street 2:ALTOONA REGIONAL HEALTH SYSTEM DEPT OF EMERGENCY MEDICI
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-4899
Practice Address - Country:US
Practice Address - Phone:814-889-2866
Practice Address - Fax:814-889-6785
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD066590L207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H12116Medicare UPIN
036254JNYMedicare ID - Type Unspecified