Basic Information
Provider Information
NPI: 1447308143
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: THOMPSON
FirstName: RHONDA
MiddleName: ALYSE
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 367 S. GULPH RD
Address2: ATT IPM CREDENTIALING
City: KING OF PRUSSIA
State: PA
PostalCode: 194063121
CountryCode: US
TelephoneNumber: 6103824943
FaxNumber: 6108783965
Practice Location
Address1: 6272 LAKE OSPREY DR
Address2:  
City: LAKEWOOD RANCH
State: FL
PostalCode: 342408425
CountryCode: US
TelephoneNumber: 9419072800
FaxNumber: 9419079434
Other Information
ProviderEnumerationDate: 01/08/2007
LastUpdateDate: 07/21/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XME93597FLY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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