Provider Demographics
NPI:1619964731
Name:THOMPSON, ROBERT J (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1259 S CEDAR CREST BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103
Mailing Address - Country:US
Mailing Address - Phone:610-437-4134
Mailing Address - Fax:610-770-0993
Practice Address - Street 1:1259 S CEDAR CREST BLVD
Practice Address - Street 2:STE 100
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103
Practice Address - Country:US
Practice Address - Phone:610-437-4134
Practice Address - Fax:610-770-0993
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD028651E207N00000X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA172424OtherHIGHMARK
PA02343000OtherCAPITAL BLUE CROSS
PA02343000OtherCAPITAL BLUE CROSS
PAD71620Medicare UPIN