Provider Demographics
NPI:1902090269
Name:DAVID D THOMPSON JR & ROBERT A LINDEN PTR
Entity type:Organization
Organization Name:DAVID D THOMPSON JR & ROBERT A LINDEN PTR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:D
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:860-739-4431
Mailing Address - Street 1:22 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NIANTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06357-2340
Mailing Address - Country:US
Mailing Address - Phone:860-739-4431
Mailing Address - Fax:860-739-9461
Practice Address - Street 1:22 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NIANTIC
Practice Address - State:CT
Practice Address - Zip Code:06357-2340
Practice Address - Country:US
Practice Address - Phone:860-739-4431
Practice Address - Fax:860-739-9461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004394813Medicaid
CTC01462Medicare PIN
CTC14796Medicare PIN