Provider Demographics
NPI:1194720904
Name:THOMPSON, JANE A (MD)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:A
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 MERRIMACK ST
Mailing Address - Street 2:RIVERWALK
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01843-1756
Mailing Address - Country:US
Mailing Address - Phone:978-557-8700
Mailing Address - Fax:978-557-8856
Practice Address - Street 1:500 MERRIMACK ST
Practice Address - Street 2:RIVERWALK
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843-1756
Practice Address - Country:US
Practice Address - Phone:978-557-8700
Practice Address - Fax:978-557-8856
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA44455207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
974952OtherNETWORK HEALTH
MA2071258Medicaid
MA4389336OtherAETNA NON HMO
MA110038375AOtherMASS HEALTH
04-01191OtherEVERCARE
MA65019OtherHARVARD PILGRIM HEALTHCAR
MA715642OtherTUFTS HEALTH PLAN
82940OtherHEALTHSOURCE
NVB97344OtherANTHEM BLUE CROSS
MA04-01191OtherEVERCARE
MA1194720904OtherAETNA HMO
MAD02060OtherBLUE CROSS BLUE SHIELD
MA1194720904OtherFALLON COMMUNITY HEALTH PLAN
NH30010751OtherNH MEDICAID
3754283OtherCIGNA HEALTHCARE
0016304OtherNEIGHBORHOOD HEALTH PLAN
MAD02060OtherHMO BLUE
110214688OtherRAILROAD MEDICARE
MA110038375AOtherMASS HEALTH
MA4389336OtherAETNA NON HMO