Healthcare Provider Details

I. General information

NPI: 1992094072
Provider Name (Legal Business Name): JOEL P THOMPSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2011
Last Update Date: 01/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

995 SENATOR KEATING BLVD STE 100
ROCHESTER NY
14618-2777
US

IV. Provider business mailing address

2263 CLINTON AVE S
ROCHESTER NY
14618-2623
US

V. Phone/Fax

Practice location:
  • Phone: 585-241-6600
  • Fax: 585-241-6630
Mailing address:
  • Phone: 585-241-6400
  • Fax: 585-241-6505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number267699
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: