Basic Information
| Provider Information | |||||||||
| NPI: | 1093763195 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THOMPSON | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3100 PLAZA PROPERTIES BLVD | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432191531 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6143836000 | ||||||||
| FaxNumber: | 6143836001 | ||||||||
| Practice Location | |||||||||
| Address1: | 3100 PLAZA PROPERTIES BLVD | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432191531 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6143836000 | ||||||||
| FaxNumber: | 6143836001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2006 | ||||||||
| LastUpdateDate: | 09/12/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | 35048176 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 000000118597 | 01 | OH | ANTHEM BC/BS | OTHER | 000000118597 | 01 | OH | ANTHEM | OTHER | 0526952 | 05 | OH | MEDICAID | 3000064 | 01 | OH | UNITED HEALTHCARE | OTHER |