Healthcare Provider Details

I. General information

NPI: 1811956568
Provider Name (Legal Business Name): KENNETH THOMPSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 12/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 JHF DR
PITTSBURGH PA
15217-2950
US

IV. Provider business mailing address

200 JHF DR
PITTSBURGH PA
15217-2950
US

V. Phone/Fax

Practice location:
  • Phone: 412-422-7442
  • Fax: 412-904-5025
Mailing address:
  • Phone: 412-422-7442
  • Fax: 412-904-5025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD045742L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: