Provider Demographics
NPI:1013136019
Name:THOMPSON MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:THOMPSON MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NITA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHATTERJEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-923-1181
Mailing Address - Street 1:415 RIVERSIDE DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NORTH GROSVENORDALE
Mailing Address - State:CT
Mailing Address - Zip Code:06255-2165
Mailing Address - Country:US
Mailing Address - Phone:860-923-1181
Mailing Address - Fax:860-923-1822
Practice Address - Street 1:415 RIVERSIDE DR
Practice Address - Street 2:SUITE 1
Practice Address - City:NORTH GROSVENORDALE
Practice Address - State:CT
Practice Address - Zip Code:06255-2165
Practice Address - Country:US
Practice Address - Phone:860-923-1181
Practice Address - Fax:860-923-1822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004221587Medicaid
CTC02585Medicare PIN