Provider Demographics
NPI:1285789834
Name:THOMPSON, LAURA A (MD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:A
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 1:4640 ADMIRALTY WAY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-6621
Mailing Address - Country:US
Mailing Address - Phone:310-836-1574
Mailing Address - Fax:310-836-6925
Practice Address - Street 1:4640 ADMIRALTY WAY
Practice Address - Street 2:SUITE 102
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-6621
Practice Address - Country:US
Practice Address - Phone:310-836-1574
Practice Address - Fax:310-836-6925
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC393992085N0904X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHW8434Medicare PIN
CAWC39399GMedicare PIN
CAWC39399BMedicare PIN
CAWC39399FMedicare PIN
CAHW13956Medicare PIN
CAA37135Medicare UPIN
CAW13956Medicare PIN