Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 0010124635 | VA |
Y | 111NI0900X | Internist | 0010124635 | VA |
N | 207RA0401X | Internist - Addiction Medicine | 0101246355 | VA |
N | 207RG0300X | Geriatric Medicine | 0010124635 | VA |
NPI | 1194913533 |
---|---|
Provider Name | James Edward Thompson |
First Address | Glen Allen, VA 23060-3314 |
Second Address | Glen Allen, VA 23060-3314 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2007 |
Last Update Date | 13/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1194913533 | (05) | VA |