Healthcare Provider Details

I. General information

NPI: 1770933814
Provider Name (Legal Business Name): ADAM MICHAEL THOMPSON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2016
Last Update Date: 09/21/2020
Certification Date: 09/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 WEST CHESTER PIKE SUITE 203
HAVERTOWN PA
19083-4540
US

IV. Provider business mailing address

525 WEST CHESTER PIKE SUITE 203
HAVERTOWN PA
19083-4540
US

V. Phone/Fax

Practice location:
  • Phone: 610-789-7767
  • Fax: 610-789-7768
Mailing address:
  • Phone: 610-789-7767
  • Fax: 610-789-7768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberOS020023
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: