Provider Demographics
NPI:1346224938
Name:THOMPSON, LOUIS M (MD)
Entity type:Individual
Prefix:
First Name:LOUIS
Middle Name:M
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 1:7130 GLEN FOREST DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-3754
Mailing Address - Country:US
Mailing Address - Phone:804-288-4084
Mailing Address - Fax:804-282-8678
Practice Address - Street 1:2240 JOHN ROLFE PKWY
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23233-6913
Practice Address - Country:US
Practice Address - Phone:804-288-4084
Practice Address - Fax:804-545-9548
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101057551174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1346224938Medicaid
VAG74439Medicare UPIN
VAVAA113149Medicare PIN