Basic Information
| Provider Information | |||||||||
| NPI: | 1912987421 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THOMPSON | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | NELSON | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4016 OLD WILLIAM PENN HWY | ||||||||
| Address2: | |||||||||
| City: | MURRYSVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 15668 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7247337544 | ||||||||
| FaxNumber: | 7243252935 | ||||||||
| Practice Location | |||||||||
| Address1: | 4016 OLD WILLIAM PENN HWY | ||||||||
| Address2: | |||||||||
| City: | MURRYSVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 15668 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7247337544 | ||||||||
| FaxNumber: | 7243252935 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | OS006762E | PA | Y | Allopathic & Osteopathic Physicians | Dermatology |
ID Information
| ID | Type | State | Issuer | Description | 0011598300003 | 05 | PA | MEDICAID | 129693 | 01 | PA | BLUE SHIELD | OTHER |