Healthcare Provider Details

I. General information

NPI: 1942251855
Provider Name (Legal Business Name): MATTHEW THOMPSON DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 01/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4850 FAYETTEVILLE RD
LUMBERTON NC
28358-2100
US

IV. Provider business mailing address

1738 METROMEDICAL DR
FAYETTEVILLE NC
28304-3861
US

V. Phone/Fax

Practice location:
  • Phone: 910-738-4811
  • Fax: 910-738-7212
Mailing address:
  • Phone: 910-484-4191
  • Fax: 910-484-5546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number158
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: