Provider Demographics
NPI:1871739045
Name:THOMPSON, MICHAEL LEE (IDC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LEE
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 BATTLEGROUND AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28560-7030
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4389 BEAUFORT RD
Practice Address - Street 2:NAVAL HEALTH CLINIC CHERRY POINT
Practice Address - City:CHERRY POINT
Practice Address - State:NC
Practice Address - Zip Code:28533
Practice Address - Country:US
Practice Address - Phone:252-466-0355
Practice Address - Fax:252-466-0476
Is Sole Proprietor?:No
Enumeration Date:2008-12-18
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman