Provider Demographics
NPI:1831267459
Name:DICKINSON, DENISE THOMPSON (MD)
Entity type:Individual
Prefix:DR
First Name:DENISE
Middle Name:THOMPSON
Last Name:DICKINSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:11911 CREEL LODGE DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-5101
Mailing Address - Country:US
Mailing Address - Phone:502-724-2449
Mailing Address - Fax:502-366-3317
Practice Address - Street 1:1700 OLD BLUEGRASS AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40215-1162
Practice Address - Country:US
Practice Address - Phone:502-366-1388
Practice Address - Fax:502-366-3317
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY22850174400000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYE40957Medicare UPIN