Provider Demographics
NPI:1992759245
Name:THOMSON, MICHAEL ANDREW (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ANDREW
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 1:77 MILLER RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CASTLETON
Mailing Address - State:NY
Mailing Address - Zip Code:12033-4022
Mailing Address - Country:US
Mailing Address - Phone:518-477-2615
Mailing Address - Fax:
Practice Address - Street 1:77 MILLER RD
Practice Address - Street 2:SUITE 201
Practice Address - City:CASTLETON
Practice Address - State:NY
Practice Address - Zip Code:12033-4022
Practice Address - Country:US
Practice Address - Phone:518-477-2615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY150911207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY53E062OtherBLUE CROSS
NY10002041OtherCDPHP
NY00875425Medicaid
NY000401526002OtherBLUE SHIELD
NY00875425Medicaid