MEDICARE: DR. SHANNON ANNE THOMPSON DPM

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	213ES0103X	Foot & Ankle Surgery Podiatrist	PO 3118	FL
2	213E00000X	Podiatrist	2341	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508830548
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHANNON ANNE THOMPSON DPM

Provider Business Mailing Address
First Line	:	52 CREST AVE
Second Line	:
City	:	WINTHROP
State	:	MA
Zip	:	02152-1064
Country	:	US
Telephone Number	:	617-539-0197
Fax Number	:	617-539-0669

Provider Business Practice Location Address
First Line	:	52 CREST AVE
Second Line	:
City	:	WINTHROP
State	:	MA
Zip	:	02152-1064
Country	:	US
Telephone Number	:	617-539-0197
Fax Number	:	617-539-0669

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

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	03/21/2012

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