Provider Demographics
NPI:1063211340
Name:THOMPSON, ADAM BOAKE
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:BOAKE
Last Name:THOMPSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 BEAUMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05405-1742
Mailing Address - Country:US
Mailing Address - Phone:612-810-2601
Mailing Address - Fax:
Practice Address - Street 1:89 BEAUMONT AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05405-1742
Practice Address - Country:US
Practice Address - Phone:612-810-2601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program