Provider Demographics
NPI:1710157615
Name:THOMPSON, ELISSA COOKE (MD)
Entity Type:Individual
Prefix:
First Name:ELISSA
Middle Name:COOKE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELISSA
Other - Middle Name:NORA
Other - Last Name:COOKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:25 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-3129
Mailing Address - Country:US
Mailing Address - Phone:508-778-1829
Mailing Address - Fax:508-778-4562
Practice Address - Street 1:25 MAIN ST
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-3129
Practice Address - Country:US
Practice Address - Phone:508-778-1829
Practice Address - Fax:508-778-0113
Is Sole Proprietor?:No
Enumeration Date:2008-03-06
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN6715207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease