Provider Demographics
NPI:1649210501
Name:JEFFREY P THOMPSEN, MD, LLC
Entity Type:Organization
Organization Name:JEFFREY P THOMPSEN, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:P
Authorized Official - Last Name:THOMPSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-687-1229
Mailing Address - Street 1:9 PALOMBA DR
Mailing Address - Street 2:SUITE 11
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-3823
Mailing Address - Country:US
Mailing Address - Phone:860-687-1229
Mailing Address - Fax:860-687-1229
Practice Address - Street 1:9 PALOMBA DR
Practice Address - Street 2:SUITE 11
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-3823
Practice Address - Country:US
Practice Address - Phone:860-687-1229
Practice Address - Fax:860-687-1229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT041802207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty