Healthcare Provider Details

I. General information

NPI: 1932502176
Provider Name (Legal Business Name): ADRIAN THOMPSON SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2014
Last Update Date: 10/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23206 GAY STREET
EUCLID OH
44123
US

IV. Provider business mailing address

23206 GAY STREET
EUCLID OH
44123
US

V. Phone/Fax

Practice location:
  • Phone: 216-347-2883
  • Fax: 216-731-0927
Mailing address:
  • Phone: 216-347-2883
  • Fax: 216-731-0927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number80-0579796
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: