Healthcare Provider Details

I. General information

NPI: 1093763195
Provider Name (Legal Business Name): MARK E THOMPSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 09/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 PLAZA PROPERTIES BLVD
COLUMBUS OH
43219-1531
US

IV. Provider business mailing address

3100 PLAZA PROPERTIES BLVD
COLUMBUS OH
43219-1531
US

V. Phone/Fax

Practice location:
  • Phone: 614-383-6000
  • Fax: 614-383-6001
Mailing address:
  • Phone: 614-383-6000
  • Fax: 614-383-6001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number35048176
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: