Provider Demographics
NPI:1811064587
Name:THOMPSON, ROBERT B (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:B
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 1:3962 STATE ROUTE 9
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-8538
Mailing Address - Country:US
Mailing Address - Phone:518-561-9609
Mailing Address - Fax:
Practice Address - Street 1:3962 STATE ROUTE 9
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-8538
Practice Address - Country:US
Practice Address - Phone:518-561-9609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY160381-1207QS0010X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P010160381OtherEXCELLUS
NY01970341Medicaid
NY141338471OtherFIDELIS
NY000490094001OtherBSNENY
0927V2OtherEMPIRE
10490635OtherCAQH
NY141338471OtherGHI
NY114406OtherVALUE OPTIONS
NY90031OtherMVP
NYP010160381OtherEXCELLUS
141338471OtherUNITED HEALTHCARE
NY141338471OtherAETNA
NY141338471OtherMARTINS POINT
220007261Medicare ID - Type UnspecifiedRAILROAD
NYP010160381OtherEXCELLUS
NY114406OtherVALUE OPTIONS