MEDICARE: DR. LAURA A 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	2085N0904X	Nuclear Radiology Physician	C39399	CA

General Provider Information

NPI Number	:	1285789834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAURA A THOMPSON M.D.

Provider Business Mailing Address
First Line	:	4640 ADMIRALTY WAY
Second Line	:	SUITE 102
City	:	MARINA DEL REY
State	:	CA
Zip	:	90292-6621
Country	:	US
Telephone Number	:	310-836-1574
Fax Number	:	310-836-6925

Provider Business Practice Location Address
First Line	:	4640 ADMIRALTY WAY
Second Line	:	SUITE 102
City	:	MARINA DEL REY
State	:	CA
Zip	:	90292-6621
Country	:	US
Telephone Number	:	310-836-1574
Fax Number	:	310-836-6925

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

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	06/14/2012

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