Provider Demographics
NPI:1003847377
Name:THOMSON, DIANNE GUARNERA (PA)
Entity Type:Individual
Prefix:
First Name:DIANNE
Middle Name:GUARNERA
Last Name:THOMSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2678 SOUTH RD STE 202
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-5254
Mailing Address - Country:US
Mailing Address - Phone:845-790-5700
Mailing Address - Fax:845-790-5719
Practice Address - Street 1:45 READE PL
Practice Address - Street 2:VASSAR BROTHERS MEDICAL CENTER
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-3947
Practice Address - Country:US
Practice Address - Phone:845-454-8500
Practice Address - Fax:845-483-6108
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010734363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6098LMedicare ID - Type Unspecified
Q62022Medicare UPIN