Provider Demographics
NPI:1306963400
Name:THOMSON, PATE D (MD)
Entity type:Individual
Prefix:DR
First Name:PATE
Middle Name:D
Last Name:THOMSON
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 1:647 CRAGMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94708-1329
Mailing Address - Country:US
Mailing Address - Phone:510-524-0568
Mailing Address - Fax:510-528-1913
Practice Address - Street 1:647 CRAGMONT AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94708-1329
Practice Address - Country:US
Practice Address - Phone:510-524-0568
Practice Address - Fax:510-528-1913
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG11694207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG00119540Medicaid
CAG00119540Medicaid
CAG00119540Medicare ID - Type Unspecified