Provider Demographics
NPI:1386756971
Name:THOMPSON, ROBERT SCOTT (DO)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:SCOTT
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2712 MIDDLEBURG DR STE 206
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-2415
Mailing Address - Country:US
Mailing Address - Phone:717-503-7675
Mailing Address - Fax:
Practice Address - Street 1:2712 MIDDLEBURG DR STE 206
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-2415
Practice Address - Country:US
Practice Address - Phone:803-348-7433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS008731L207P00000X, 207Q00000X
SC36644207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1514927OtherGATEWAY
PA50010854OtherCAPITAL BC
PA001372027OtherHIGHMARK BS
PA0015160850002Medicaid
PA0015160850004Medicaid
PA148609OtherUNISON
PA73861OtherGEISINGER
PA1514927OtherGATEWAY
PAF72425Medicare UPIN
PA0015160850004Medicaid