Provider Demographics
NPI:1689601627
Name:THOMPSON, CRAIG ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:ALAN
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 1:6 STONEPOST RD
Mailing Address - Street 2:
Mailing Address - City:SIMSBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06070-2512
Mailing Address - Country:US
Mailing Address - Phone:802-369-6250
Mailing Address - Fax:
Practice Address - Street 1:85 SEYMOUR ST STE 1022
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-5530
Practice Address - Country:US
Practice Address - Phone:860-972-3570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT47324207RI0011X, 207RC0000X
NY267395207RC0000X
NH12124207RI0011X
CODR.0071359207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30203648Medicaid
VT1009855Medicaid
VT1009855Medicaid
H67663Medicare UPIN