Healthcare Provider Details

I. General information

NPI: 1942208202
Provider Name (Legal Business Name): ERIC MICHAEL THOMPSON DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 08/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 MERLINE RD SUITE 101
VERNON CT
06066-4040
US

IV. Provider business mailing address

196 PARKWAY S SUITE 304
WATERFORD CT
06385-1234
US

V. Phone/Fax

Practice location:
  • Phone: 860-875-8275
  • Fax: 860-875-8991
Mailing address:
  • Phone: 860-442-7027
  • Fax: 860-444-0074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number000750
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number000750
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: