MEDICARE: DR. MELISSA LANE THOMPSON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	J0312	TX

General Provider Information

NPI Number	:	1366430472
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MELISSA LANE THOMPSON M.D.

Provider Business Mailing Address
First Line	:	PO BOX 2295
Second Line	:
City	:	ASHEVILLE
State	:	NC
Zip	:	28802-2295
Country	:	US
Telephone Number	:	828-398-5244
Fax Number	:	828-360-3080

Provider Business Practice Location Address
First Line	:	68-1602 LAIE ST
Second Line	:
City	:	WAIKOLOA
State	:	HI
Zip	:	96738
Country	:	US
Telephone Number	:	281-744-2374
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2005
Last Update Date	:	10/17/2017

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