MEDICARE: MARK THOMPSON MD

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	207T00000X	Neurological Surgery Physician	208307-1	NY
2	207T00000X	Neurological Surgery Physician	4301097635	MI

General Provider Information

NPI Number	:	1427043454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK THOMPSON MD

Provider Business Mailing Address
First Line	:	400 E 71ST ST
Second Line	:	APT 11E
City	:	NEW YORK
State	:	NY
Zip	:	10021-4808
Country	:	US
Telephone Number	:	212-327-1958
Fax Number	:	212-327-1956

Provider Business Practice Location Address
First Line	:	400 E 71ST ST
Second Line	:	APT 11E
City	:	NEW YORK
State	:	NY
Zip	:	10021-4808
Country	:	US
Telephone Number	:	212-327-1958
Fax Number	:	212-327-1956

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

Provider Enumeration Date	:	09/15/2005
Last Update Date	:	03/26/2018

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Directions to “ MARK THOMPSON MD” Practice Location

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