Provider Demographics
NPI:1750369278
Name:THORNSON, WILLIAM L (PA-C)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:L
Last Name:THORNSON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02724-3348
Mailing Address - Country:US
Mailing Address - Phone:508-984-5671
Mailing Address - Fax:
Practice Address - Street 1:890 BROCK AVE
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02744-1626
Practice Address - Country:US
Practice Address - Phone:508-984-5671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA288572363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAP0957Medicare ID - Type Unspecified
MAS70948Medicare UPIN