Provider Demographics
NPI:1437219110
Name:THOMSON, JOANN (MD)
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:
Last Name:THOMSON
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 1:350 E 82ND ST
Mailing Address - Street 2:2A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-4909
Mailing Address - Country:US
Mailing Address - Phone:212-794-7246
Mailing Address - Fax:212-794-7247
Practice Address - Street 1:350 E 82ND ST
Practice Address - Street 2:2A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-4909
Practice Address - Country:US
Practice Address - Phone:212-794-7246
Practice Address - Fax:212-794-7247
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY201456207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00246075Medicaid
00330231Medicare ID - Type Unspecified