Healthcare Provider Details

I. General information

NPI: 1194913533
Provider Name (Legal Business Name): JAMES EDWARD THOMPSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2007
Last Update Date: 08/13/2020
Certification Date: 08/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4212 PARK PLACE CT
GLEN ALLEN VA
23060-3314
US

IV. Provider business mailing address

4212 PARK PLACE CT
GLEN ALLEN VA
23060-3314
US

V. Phone/Fax

Practice location:
  • Phone: 804-332-5950
  • Fax: 804-728-1086
Mailing address:
  • Phone: 804-332-5950
  • Fax: 804-728-1086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0010124635
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number0101246355
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number0010124635
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: