Healthcare Provider Details

I. General information

NPI: 1174550032
Provider Name (Legal Business Name): GEORGE GRAHAM THOMSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: GEORDIE GRAHAM THOMSON M.D.

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 01/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

174 CONCORD ST STE 280
PETERBOROUGH NH
03458-1222
US

IV. Provider business mailing address

3 RIVER ST
PETERBOROUGH NH
03458-1405
US

V. Phone/Fax

Practice location:
  • Phone: 603-924-3644
  • Fax: 603-924-7420
Mailing address:
  • Phone: 603-924-3644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number8923
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number8923
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: