Provider Demographics
NPI:1346346996
Name:THOMPSON, ROSEMARIE (RD)
Entity Type:Individual
Prefix:
First Name:ROSEMARIE
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000510133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT270000510CT01OtherANTHEM BLUE CROSS