MEDICARE: DR. SUSAN N THOMPSON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	54979	MA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
10	1104824804	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1104824804	OTHER		HEALTH NEW ENGLAND
2	1104824804	OTHER		CIGNA
3	1104824804	OTHER		TUFTS
4	1104824804	OTHER		UNITED HEALTH CARE PLAN SPECIFIC
5	1104824804	OTHER		AETNA
6	1104824804	OTHER	MA	BOSTON MEDICAL HEALTH PLAN
7	1104824804	OTHER		CDPHP
8	1104824804	OTHER		FALLON
9	1104824804	OTHER		MVP
11	1104824804	OTHER	MA	BC/BS MA - BLUE CARD PPO
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
13	1104824804	OTHER		HARVARD PILGRM HEALTH CARE

General Provider Information

NPI Number	:	1104824804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN N THOMPSON M.D.

Provider Business Mailing Address
First Line	:	63 STATE RD
Second Line	:
City	:	GREAT BARRINGTON
State	:	MA
Zip	:	01230-1223
Country	:	US
Telephone Number	:	413-644-9933
Fax Number	:	413-644-9433

Provider Business Practice Location Address
First Line	:	63 STATE RD
Second Line	:
City	:	GREAT BARRINGTON
State	:	MA
Zip	:	01230-1223
Country	:	US
Telephone Number	:	413-644-9933
Fax Number	:	413-644-9433

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	11/26/2012

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