MEDICARE: BENJAMIN THOMPSON PA-C

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	363A00000X	Physician Assistant		NC
2	363A00000X	Physician Assistant	0010-10641	NC

General Provider Information

NPI Number	:	1487269973
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENJAMIN THOMPSON PA-C

Provider Business Mailing Address
First Line	:	110 EMILY RD
Second Line	:
City	:	CHAPEL HILL
State	:	NC
Zip	:	27514-1944
Country	:	US
Telephone Number	:	336-337-1458
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 VILLAGE CENTER DR STE 1002
Second Line	:
City	:	CHAPEL HILL
State	:	NC
Zip	:	27516-7189
Country	:	US
Telephone Number	:	984-215-6550
Fax Number	:

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

Provider Enumeration Date	:	09/10/2020
Last Update Date	:	04/07/2026

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