=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255436382
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | THOMAS H. LAMPE M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/13/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | VA PUGET SOUND HCS AMERICAN LAKE DIVISION 116POC
-----------------------------------------------------
City | TACOMA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98493-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-582-8440
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14156 SE 255TH ST
-----------------------------------------------------
City | KENT
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98042-6621
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-639-0908
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0805X
-----------------------------------------------------
Taxonomy Name | Geriatric Psychiatry Physician
-----------------------------------------------------
License Number | MD00017174
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------