Healthcare Provider Details

I. General information

NPI: 1992789804
Provider Name (Legal Business Name): DAVID FRANK TARA THOMPSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 10/20/2022
Certification Date: 10/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 PORTER DR
MIDDLEBURY VT
05753-8629
US

IV. Provider business mailing address

115 PORTER DR
MIDDLEBURY VT
05753-8629
US

V. Phone/Fax

Practice location:
  • Phone: 802-388-4736
  • Fax:
Mailing address:
  • Phone: 802-388-4736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA65066
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number042-0016416
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: