MEDICARE: AMELIA BIANCA THOMPSON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080P0208X	Pediatric Infectious Diseases Physician	2017-00836	NC
2	2080P0208X	Pediatric Infectious Diseases Physician	ME144340	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134418726
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMELIA BIANCA THOMPSON M.D.

Provider Business Mailing Address
First Line	:	615 E PRINCETON ST STE 401
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32803-1469
Country	:	US
Telephone Number	:	407-303-9194
Fax Number	:	407-303-9273

Provider Business Practice Location Address
First Line	:	615 E PRINCETON ST STE 401
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32803-1469
Country	:	US
Telephone Number	:	407-303-9194
Fax Number	:	407-303-9273

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2011
Last Update Date	:	07/23/2020

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