Provider Demographics
NPI:1548435225
Name:THOMPSON, OLGA VADIM (MD)
Entity type:Individual
Prefix:
First Name:OLGA
Middle Name:VADIM
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:OLGA
Other - Middle Name:VADIM
Other - Last Name:YAKIMENKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1695 KERNERVILLE MEDICAL PARKWAY
Mailing Address - Street 2:MENTAL HEALTH
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284
Mailing Address - Country:US
Mailing Address - Phone:336-407-0522
Mailing Address - Fax:
Practice Address - Street 1:1695 KERNERVILLE MEDICAL PARKWAY
Practice Address - Street 2:MENTAL HEALTH
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284
Practice Address - Country:US
Practice Address - Phone:336-407-0522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY242776207ZP0102X
NC1833412084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1989OtherJULIE'S DATE OF BIRTH