Provider Demographics
NPI:1821010869
Name:THORNTON, KRISTEN L (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:L
Last Name:THORNTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:845 3RD AVE
Mailing Address - Street 2:FL 6
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-6630
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5015 CAMPUSWOOD DR STE 107
Practice Address - Street 2:
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-4236
Practice Address - Country:US
Practice Address - Phone:315-204-0397
Practice Address - Fax:855-418-2317
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY252985207QG0300X
NY252985-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine