Individual
CHARLES THOMPSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5178 MILANO ST, AVE MARIA, FL 34142-9548
(860) 460-7195
(860) 460-7195
Mailing address
5178 MILANO ST, AVE MARIA, FL 34142-9548
(860) 460-7195
(860) 460-7195
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
039780
CT
208000000X
Pediatrics Physician
Primary
ME137399
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001397802
—
CT
Enumeration date
02/27/2006
Last updated
03/10/2024
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