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General NPI Number Information
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NPI Number | 1659993459
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Entity Type | Individual
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Provider Name | MATT THOMPSON MA MB.BS MD FRCS
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Gender | Male
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Dates
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Enumeration Date | 05/14/2020
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Last Update Date | 05/14/2020
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Provider Practice Location Address
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Address Line | DEPARTMENT OF VASCULAR SURGERY 9500 EUCLID AVENUE
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City | CLEVELAND
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State | OH
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Zip | 44195-0001
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Country | US
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Telephone | 216-444-3581
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Fax |
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Provider Business Mailing Address
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Address Line | 153 EPISODE
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City | IRVINE
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State | CA
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Zip | 92618-1379
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Country | US
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Telephone | 949-468-8454
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 75.000028
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License Number State | OH
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