Provider Demographics
NPI:1952394264
Name:THOMPSON, VAN ERIC (MD)
Entity Type:Individual
Prefix:DR
First Name:VAN
Middle Name:ERIC
Last Name:THOMPSON
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 1:6 OLD CASTLE DRIVE
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06470
Mailing Address - Country:US
Mailing Address - Phone:573-424-8810
Mailing Address - Fax:573-256-3071
Practice Address - Street 1:6 OLD CASTLE DRIVE
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:CT
Practice Address - Zip Code:06470
Practice Address - Country:US
Practice Address - Phone:573-424-8810
Practice Address - Fax:573-256-3071
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR3L94208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOE52231Medicare UPIN
MO017012740Medicare PIN