Provider Demographics
NPI:1871522862
Name:THOMPSON, CHRISTINE C (MD)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:C
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 RALSTON CT
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3572
Mailing Address - Country:US
Mailing Address - Phone:843-884-3656
Mailing Address - Fax:
Practice Address - Street 1:2690 LAKE PARK DR
Practice Address - Street 2:
Practice Address - City:N CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9100
Practice Address - Country:US
Practice Address - Phone:843-764-0992
Practice Address - Fax:843-764-3187
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-02
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13532174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist