Provider Demographics
NPI:1083296453
Name:THOMSON, AVERY
Entity Type:Individual
Prefix:
First Name:AVERY
Middle Name:
Last Name:THOMSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 S 9TH ST APT 2FN
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-1313
Mailing Address - Country:US
Mailing Address - Phone:561-400-3576
Mailing Address - Fax:
Practice Address - Street 1:51 N 39TH STREET
Practice Address - Street 2:MEDICAL ARTS BUILDING, SUITE 211
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104
Practice Address - Country:US
Practice Address - Phone:215-662-9664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program