Provider Demographics
NPI:1215995758
Name:THOMPSON, CRAIG S (MD)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:S
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:L-3652
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43260-0001
Mailing Address - Country:US
Mailing Address - Phone:740-383-7831
Mailing Address - Fax:740-375-8137
Practice Address - Street 1:1040 DELAWARE AVENUE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43301-1814
Practice Address - Country:US
Practice Address - Phone:740-383-7831
Practice Address - Fax:740-375-8137
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.047688207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
311098079OtherTAX ID
311098079OtherTAX ID E
353077OtherSUBMITTER NO
311098079OtherPPO NEXT
634340OtherAETNA
OH0492748Medicaid
311098079026OtherCIGNA
0639721OtherPALMETTO MEDICARE
OH000000118411OtherANTHEM
0400770OtherUHC
110064315OtherTRAVELERS MEDICARE
E29687Medicare UPIN
353077OtherSUBMITTER NO
311098079OtherTAX ID E