Individual
KYLE THOMPSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4170 CITY AVE, PHILADELPHIA, PA 19131-1610
(215) 871-6100
Mailing address
4190 CITY AVE, PHILADELPHIA, PA 19131-1626
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
25MP00655000
NJ
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/22/2021
Last updated
11/02/2021
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