Provider Demographics
NPI:1376526442
Name:THOMPSON, ROGER MCLACHLAN (MD)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:MCLACHLAN
Last Name:THOMPSON
Suffix:
Gender:M
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:PO BOX 8519
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-8519
Mailing Address - Country:US
Mailing Address - Phone:732-460-9840
Mailing Address - Fax:732-460-9848
Practice Address - Street 1:18 LEONARDVILLE RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NJ
Practice Address - Zip Code:07748-2311
Practice Address - Country:US
Practice Address - Phone:732-671-0860
Practice Address - Fax:732-671-6467
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA4286300207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ450873OtherUNITED HEALTHCARE
875121OtherAETNA CAPITATION
0035653OtherAETNA HMO
NJ7041706OtherCIGNA
NJ4794303Medicaid
4308075OtherAETNA
NY63D621OtherEMPIRE BC/BS
080059317OtherRAILROAD MEDICARE
NY63D622OtherEMPIRE BC/BS
NJMP172OtherOXFORD
NJ0K4746OtherHEALTH NET
4308075OtherAETNA