Provider Demographics
NPI:1659308419
Name:THOMPSON, C SCOTT (DO)
Entity Type:Individual
Prefix:
First Name:C
Middle Name:SCOTT
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 LONG POND ROAD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626
Mailing Address - Country:US
Mailing Address - Phone:585-368-4350
Mailing Address - Fax:585-227-7324
Practice Address - Street 1:1100 LONG POND ROAD
Practice Address - Street 2:SUITE 250
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626
Practice Address - Country:US
Practice Address - Phone:585-368-4350
Practice Address - Fax:585-227-7324
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY218959207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02115915Medicaid
2189595WOPCFPOtherWORKERS COMP
000526512003OtherHEALTH NOW
5996336OtherGHI
110376BFOtherPREFERRED CARE
7575367OtherAETNA
RA5141Medicare ID - Type Unspecified
110376BFOtherPREFERRED CARE