Provider Demographics
NPI:1104824804
Name:THOMPSON, SUSAN N (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:N
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 STATE RD
Mailing Address - Street 2:
Mailing Address - City:GREAT BARRINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01230-1223
Mailing Address - Country:US
Mailing Address - Phone:413-644-9933
Mailing Address - Fax:413-644-9433
Practice Address - Street 1:63 STATE RD
Practice Address - Street 2:
Practice Address - City:GREAT BARRINGTON
Practice Address - State:MA
Practice Address - Zip Code:01230-1223
Practice Address - Country:US
Practice Address - Phone:413-644-9933
Practice Address - Fax:413-644-9433
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA54979207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1104824804OtherHEALTH NEW ENGLAND
1104824804OtherCIGNA
1104824804OtherTUFTS
1104824804OtherUNITED HEALTH CARE PLAN SPECIFIC
1104824804OtherAETNA
MA1104824804OtherBOSTON MEDICAL HEALTH PLAN
1104824804OtherCDPHP
1104824804OtherFALLON
1104824804OtherMVP
1104824804OtherRAILROAD MEDICARE
MA1104824804OtherBC/BS MA - BLUE CARD PPO
MA11004271AMedicaid
1104824804OtherHARVARD PILGRM HEALTH CARE
MA11004271AMedicaid