Provider Demographics
NPI:1649511379
Name:THOMPSON, COLLEEN (PA)
Entity type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:
Other - Last Name:SORENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:201 EDGEWATER DR STE 215
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-6216
Mailing Address - Country:US
Mailing Address - Phone:617-426-0600
Mailing Address - Fax:
Practice Address - Street 1:201 EDGEWATER DR STE 215
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-6216
Practice Address - Country:US
Practice Address - Phone:617-426-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-05
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA4630363AM0700X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical