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General NPI Number Information
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NPI Number | 1750783619
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Entity Type | Organization
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Legal Business Name | THOMPSON MEDICAL LLC
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Dates
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Enumeration Date | 09/23/2014
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Last Update Date | 11/25/2024
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Provider Practice Location Address
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Address Line | 415 RIVERSIDE DR
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City | NORTH GROSVENORDALE
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State | CT
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Zip | 06255-2165
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Country | US
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Telephone | 860-923-1190
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Fax | 860-923-0134
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Provider Business Mailing Address
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Address Line | 415 RIVERSIDE DR
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City | NORTH GROSVENORDALE
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State | CT
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Zip | 06255-2165
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Country | US
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Telephone | 860-923-1190
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Fax | 860-923-0134
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | LISA A CODERRE
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Credential |
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Telephone | 860-923-1181
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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