Provider Demographics
NPI:1063511772
Name:THOMPSON, LARS DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:LARS
Middle Name:DAVID
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:100 METROPOLITAN PARK DR STE 100
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-7112
Mailing Address - Country:US
Mailing Address - Phone:315-870-9369
Mailing Address - Fax:315-870-9364
Practice Address - Street 1:80 E MAIN ST STE 2A
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:NY
Practice Address - Zip Code:13617-1400
Practice Address - Country:US
Practice Address - Phone:315-714-2559
Practice Address - Fax:315-386-3056
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2022-10-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY217623208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02082882Medicaid
NYCC1029Medicare PIN