Provider Demographics
NPI:1316043763
Name:DENIZARD-THOMPSON, NANCY MARIE (MD)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:MARIE
Last Name:DENIZARD-THOMPSON
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:
Other - Last Name:DENIZARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:MEDICAL CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27157-0001
Mailing Address - Country:US
Mailing Address - Phone:336-713-4156
Mailing Address - Fax:
Practice Address - Street 1:MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157
Practice Address - Country:US
Practice Address - Phone:336-713-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2006-01143207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC143K7OtherBCBS
WV3810007102Medicaid
VA10406854Medicaid
SCQ43006Medicaid
NC7515864OtherAETNA
NC808452OtherPARTNERS
NC5905491Medicaid
NC191795OtherMEDCOST
SCQ43006Medicaid
NCP00397966Medicare PIN