Provider Demographics
NPI:1215931704
Name:THOMPSON, DOUGLAS C (MD)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:C
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 1:655 AFRICA RD
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-9808
Mailing Address - Country:US
Mailing Address - Phone:614-326-2672
Mailing Address - Fax:
Practice Address - Street 1:4885 OLENTANGY RIVER RD STE 2-50
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-1993
Practice Address - Country:US
Practice Address - Phone:614-451-1551
Practice Address - Fax:614-451-2326
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35076981207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2227521Medicaid
OHH40883Medicare UPIN
OHTH4264831Medicare PIN