MEDICARE: CHARLES 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	208000000X	Pediatrics Physician	039780	CT
2	208000000X	Pediatrics Physician	ME137399	FL

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	:	1932175015
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES THOMPSON MD

Provider Business Mailing Address
First Line	:	5178 MILANO ST
Second Line	:
City	:	AVE MARIA
State	:	FL
Zip	:	34142-9548
Country	:	US
Telephone Number	:	860-460-7195
Fax Number	:	860-460-7195

Provider Business Practice Location Address
First Line	:	5178 MILANO ST
Second Line	:
City	:	AVE MARIA
State	:	FL
Zip	:	34142-9548
Country	:	US
Telephone Number	:	860-460-7195
Fax Number	:	860-460-7195

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

Provider Enumeration Date	:	02/27/2006
Last Update Date	:	03/10/2024

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Directions to “ CHARLES THOMPSON MD” Practice Location

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