Provider Demographics
NPI:1063410702
Name:THOMPSON, GREGORY M (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:M
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:140 W GERMANTOWN PIKE
Mailing Address - Street 2:STE 250
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462-1421
Mailing Address - Country:US
Mailing Address - Phone:484-530-0205
Mailing Address - Fax:484-530-0209
Practice Address - Street 1:255 W LANCASTER AVE
Practice Address - Street 2:PMOB III, SUITE 333
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1763
Practice Address - Country:US
Practice Address - Phone:610-644-9600
Practice Address - Fax:610-644-0804
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2020-02-05
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Provider Licenses
StateLicense IDTaxonomies
PAMD04339E208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA557113OtherHIGHMARK BS
PA03752592000OtherIBC
PA0011574150003Medicaid
PAA54918Medicare UPIN
PA4956970001Medicare NSC
PA557113Medicare PIN