Healthcare Provider Details

I. General information

NPI: 1639564800
Provider Name (Legal Business Name): DAVID TIMOTHY THOMPSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2015
Last Update Date: 07/08/2020
Certification Date: 07/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7810 5 MILE RD
CINCINNATI OH
45230-2356
US

IV. Provider business mailing address

9905 SHELBYVILLE RD
LOUISVILLE KY
40223-2907
US

V. Phone/Fax

Practice location:
  • Phone: 513-246-7000
  • Fax: 513-246-2876
Mailing address:
  • Phone: 502-425-5166
  • Fax: 502-327-0526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number51499
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35139480
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: