Healthcare Provider Details

I. General information

NPI: 1811064587
Provider Name (Legal Business Name): ROBERT B THOMPSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 03/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3962 STATE ROUTE 9
PLATTSBURGH NY
12901-8538
US

IV. Provider business mailing address

3962 STATE ROUTE 9
PLATTSBURGH NY
12901-8538
US

V. Phone/Fax

Practice location:
  • Phone: 518-561-9609
  • Fax:
Mailing address:
  • Phone: 518-561-9609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number160381-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number160381-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: