Provider Demographics
NPI:1326144973
Name:ROSEMARIE THOMPSON, RD
Entity Type:Organization
Organization Name:ROSEMARIE THOMPSON, RD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSEMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:860-741-3222
Mailing Address - Street 1:701 ENFIELD ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-2961
Mailing Address - Country:US
Mailing Address - Phone:860-741-3222
Mailing Address - Fax:860-741-3222
Practice Address - Street 1:701 ENFIELD ST
Practice Address - Street 2:SUITE 202
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-2961
Practice Address - Country:US
Practice Address - Phone:860-741-3222
Practice Address - Fax:860-741-3222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000510133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT270000510CT01OtherANTHEM BLUE CROSS
CT270000510CT01OtherANTHEM BLUE CROSS