Provider Demographics
NPI:1972611150
Name:THOMSON, JENNIFER K (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:K
Last Name:THOMSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-2442
Mailing Address - Country:US
Mailing Address - Phone:508-431-5100
Mailing Address - Fax:508-431-1515
Practice Address - Street 1:159 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-2442
Practice Address - Country:US
Practice Address - Phone:508-431-5100
Practice Address - Fax:508-431-1515
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA216868208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA206391OtherHPHC
MA67662OtherFALLON
410768OtherRI BLUE CHIP
MA2009676Medicaid
MA216868OtherTUFTS
MA000000027448OtherBMC HEALTH NET
1203558OtherUHC
MAJ26178OtherMABC
MAH86301Medicare UPIN
MA67662OtherFALLON