Provider Demographics
NPI:1891869749
Name:THOMPSON, BOBBIE JEAN
Entity type:Individual
Prefix:MRS
First Name:BOBBIE
Middle Name:JEAN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BOBBIE JEAN THOMPSON
Mailing Address - Street 2:34 CANTERBURY RD
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-4702
Mailing Address - Country:US
Mailing Address - Phone:434-971-3560
Mailing Address - Fax:434-984-6243
Practice Address - Street 1:169 SEMINOLE CT
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-2848
Practice Address - Country:US
Practice Address - Phone:434-974-7500
Practice Address - Fax:434-984-6243
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VACC19698947335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4358000001Medicare ID - Type Unspecified