Healthcare Provider Details

I. General information

NPI: 1508785007
Provider Name (Legal Business Name): MATTHEW THOMPSON CSFA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 GALLOWS RD
FALLS CHURCH VA
22042-3300
US

IV. Provider business mailing address

17677 HAMPSTEAD RIDGE CT
DUMFRIES VA
22026-4549
US

V. Phone/Fax

Practice location:
  • Phone: 703-776-8711
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number0136001142
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: