Healthcare Provider Details

I. General information

NPI: 1902876733
Provider Name (Legal Business Name): MARK E THOMPSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 ELLICOTT ST
BUFFALO NY
14203-1021
US

IV. Provider business mailing address

65 PLANTATION CT
EAST AMHERST NY
14051-1645
US

V. Phone/Fax

Practice location:
  • Phone: 716-323-6570
  • Fax:
Mailing address:
  • Phone: 806-407-7969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number48735
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number227414
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number227415
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number48735
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: