Healthcare Provider Details

I. General information

NPI: 1629655790
Provider Name (Legal Business Name): PETRIA-GEORGE SALEWA THOMPSON MD, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PETRIA THOMPSON MD, PHD

II. Dates (important events)

Enumeration Date: 03/25/2021
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 MOUNT AUBURN ST
CAMBRIDGE MA
02138-5502
US

IV. Provider business mailing address

330 MOUNT AUBURN ST
CAMBRIDGE MA
02138-5502
US

V. Phone/Fax

Practice location:
  • Phone: 617-499-5639
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number1027920
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: