Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 066958 | OH |
NPI | 1942324918 |
---|---|
Provider Name | Dr. Sudha Swamy Thompson |
First Address | Powell, OH 43065-8642 |
Second Address | Marysville, OH 43040-9256 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2007 |
Last Update Date | 08/07/2007 |