Healthcare Provider Details

I. General information

NPI: 1376526442
Provider Name (Legal Business Name): ROGER MCLACHLAN THOMPSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 04/12/2022
Certification Date: 04/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 LEONARDVILLE RD
MIDDLETOWN NJ
07748-2311
US

IV. Provider business mailing address

PO BOX 8519
RED BANK NJ
07701-8519
US

V. Phone/Fax

Practice location:
  • Phone: 732-671-0860
  • Fax: 732-671-6467
Mailing address:
  • Phone: 732-460-9840
  • Fax: 732-460-9848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MA4286300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: