Provider Demographics
NPI:1992899868
Name:THOMPSON, WILLIAM OTTO (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:OTTO
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:695 DUTCHESS TPKE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-6442
Mailing Address - Country:US
Mailing Address - Phone:845-473-2100
Mailing Address - Fax:845-473-2910
Practice Address - Street 1:695 DUTCHESS TPKE
Practice Address - Street 2:SUUITE 206
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-6442
Practice Address - Country:US
Practice Address - Phone:845-473-2100
Practice Address - Fax:845-473-2910
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY207208204C00000X, 207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery