Provider Demographics
NPI:1861445959
Name:THOMSON, DONALD JOHN (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:JOHN
Last Name:THOMSON
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 1:20 HOPE AVE
Mailing Address - Street 2:STE 103
Mailing Address - City:WALITHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-2786
Mailing Address - Country:US
Mailing Address - Phone:781-891-9170
Mailing Address - Fax:781-899-3425
Practice Address - Street 1:20 HOPE AVE
Practice Address - Street 2:STE 103
Practice Address - City:WALITHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-2786
Practice Address - Country:US
Practice Address - Phone:781-891-9170
Practice Address - Fax:781-899-3425
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA307772084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME11005OtherHARVARD PILGRIM
MA2020157Medicaid
MA030777OtherTUFTS
ME11005OtherHARVARD PILGRIM
B75513Medicare UPIN