Healthcare Provider Details

I. General information

NPI: 1811573728
Provider Name (Legal Business Name): COREY ALEXANDER THOMPSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2021
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

697 THOMAS LN
COLUMBUS OH
43214-3931
US

IV. Provider business mailing address

697 THOMAS LN
COLUMBUS OH
43214-3931
US

V. Phone/Fax

Practice location:
  • Phone: 614-566-5414
  • Fax: 614-533-0433
Mailing address:
  • Phone: 614-566-5414
  • Fax: 614-533-0433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberDR.0069337
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: