Healthcare Provider Details

I. General information

NPI: 1467763946
Provider Name (Legal Business Name): KELSEY THOMPSON MARTIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2010
Last Update Date: 10/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 INDIAN RIVER RD STE A1
ORANGE CT
06477-3690
US

IV. Provider business mailing address

240 INDIAN RIVER RD STE A1
ORANGE CT
06477-3690
US

V. Phone/Fax

Practice location:
  • Phone: 203-795-1664
  • Fax:
Mailing address:
  • Phone: 203-795-1665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number270677
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number62011
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: