Healthcare Provider Details

I. General information

NPI: 1346224938
Provider Name (Legal Business Name): LOUIS M THOMPSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 03/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2240 JOHN ROLFE PKWY
RICHMOND VA
23233-6913
US

IV. Provider business mailing address

7130 GLEN FOREST DR SUITE 101
RICHMOND VA
23226-3754
US

V. Phone/Fax

Practice location:
  • Phone: 804-288-4084
  • Fax: 804-545-9548
Mailing address:
  • Phone: 804-288-4084
  • Fax: 804-282-8678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number0101057551
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: