Provider Demographics
NPI:1790737104
Name:THOMPSON, ERIC NEIL (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:NEIL
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 1:495 ROUTE 184
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-6228
Mailing Address - Country:US
Mailing Address - Phone:860-449-1413
Mailing Address - Fax:860-449-0390
Practice Address - Street 1:495 ROUTE 184
Practice Address - Street 2:SUITE 300
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-6228
Practice Address - Country:US
Practice Address - Phone:860-449-1413
Practice Address - Fax:860-449-0390
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT025358174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
D02481Medicare UPIN