Provider Demographics
NPI:1174563084
Name:THOMPSON, GEORGE R (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:R
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WHITE SULPHUR SPRINGS
Mailing Address - State:WV
Mailing Address - Zip Code:24986-2414
Mailing Address - Country:US
Mailing Address - Phone:304-536-4870
Mailing Address - Fax:304-536-1664
Practice Address - Street 1:320 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WHITE SULPHUR SPRINGS
Practice Address - State:WV
Practice Address - Zip Code:24986-2414
Practice Address - Country:US
Practice Address - Phone:304-536-4870
Practice Address - Fax:304-536-8010
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV14406207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV110048099OtherRAILROAD PTAN
WV000446111OtherBLUE CROSS BLUE SHIELD
WV8804751Medicare PIN
B42388Medicare UPIN