Provider Demographics
NPI:1215914718
Name:THOMPSON, MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 ROUTE 108
Mailing Address - Street 2:
Mailing Address - City:SOMERSWORTH
Mailing Address - State:NH
Mailing Address - Zip Code:03878-1522
Mailing Address - Country:US
Mailing Address - Phone:603-749-2346
Mailing Address - Fax:603-953-0066
Practice Address - Street 1:311 ROUTE 108
Practice Address - Street 2:
Practice Address - City:SOMERSWORTH
Practice Address - State:NH
Practice Address - Zip Code:03878-1522
Practice Address - Country:US
Practice Address - Phone:603-749-2346
Practice Address - Fax:603-953-0066
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH11435207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30202058Medicaid
NHRE6845OtherMEDICARE PTAN
NHRE6845Medicare UPIN
NHH67668Medicare UPIN