Provider Demographics
NPI:1326010927
Name:THOMPSON, CHARLES R (ATC)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:R
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 71
Mailing Address - Street 2:PRINCETON UNIVERSITY
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08544-0071
Mailing Address - Country:US
Mailing Address - Phone:609-258-3527
Mailing Address - Fax:609-258-7045
Practice Address - Street 1:CALDWELL FIELD HOUSE
Practice Address - Street 2:PRINCETON UNIVERSITY
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08544-0001
Practice Address - Country:US
Practice Address - Phone:609-258-3527
Practice Address - Fax:609-258-7045
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT00004300174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist