Healthcare Provider Details

I. General information

NPI: 1689601627
Provider Name (Legal Business Name): CRAIG ALAN THOMPSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 12/07/2023
Certification Date: 12/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 SEYMOUR ST STE 1022
HARTFORD CT
06106-5530
US

IV. Provider business mailing address

6 STONEPOST RD
SIMSBURY CT
06070-2512
US

V. Phone/Fax

Practice location:
  • Phone: 860-972-3570
  • Fax:
Mailing address:
  • Phone: 802-369-6250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number47324
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number267395
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number47324
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number12124
License Number StateNH
# 5
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberDR.0071359
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: