Healthcare Provider Details

I. General information

NPI: 1699713297
Provider Name (Legal Business Name): DAVID GROVER THOMPSON PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 09/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E LANCASTER AVE
WYNNEWOOD PA
19096-3450
US

IV. Provider business mailing address

100 EAST LANCASTER AVENUE LANKENAU MEDICAL CENTER
WYNNEWOOD PA
19096
US

V. Phone/Fax

Practice location:
  • Phone: 484-476-2000
  • Fax:
Mailing address:
  • Phone: 484-476-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberMA051406
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: