Provider Demographics
NPI:1780650390
Name:THOMPSON, CARSON JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:CARSON
Middle Name:JOSEPH
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 1:1000 E MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18711-0027
Mailing Address - Country:US
Mailing Address - Phone:570-808-6026
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:1000 E MOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18711-0027
Practice Address - Country:US
Practice Address - Phone:570-808-6026
Practice Address - Fax:570-271-6578
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD019602E207T00000X
NY238733-1207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008602180004Medicaid
PACC9269OtherRR MEDICARE GROUP
PAGU039843OtherPA MEDICARE GROUP
PAP00260894OtherRR MEDICARE PIN
NY02672833Medicaid
C30810Medicare UPIN
NY02672833Medicaid