Basic Information
| Provider Information | |||||||||
| NPI: | 1326013509 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THOMPSON | ||||||||
| FirstName: | PETER | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3 COOPER PLZ | ||||||||
| Address2: | SUITE 502 | ||||||||
| City: | CAMDEN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 081031438 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8569636888 | ||||||||
| FaxNumber: | 8569688499 | ||||||||
| Practice Location | |||||||||
| Address1: | 3 COOPER PLZ | ||||||||
| Address2: | SUITE 411 | ||||||||
| City: | CAMDEN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 081031438 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8563423014 | ||||||||
| FaxNumber: | 8563422817 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2006 | ||||||||
| LastUpdateDate: | 04/29/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 25MA04898900 | NJ | N | Allopathic & Osteopathic Physicians | Surgery | 2086S0127X | 25MA04898900 | NJ | Y | Allopathic & Osteopathic Physicians | Surgery | Trauma Surgery | 2086S0129X | 25MA04898900 | NJ | N | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1167806 | 01 | NJ | HORIZON MERCY | OTHER | 6031803 | 05 | NJ | MEDICAID | AT000006700 | 01 | NJ | AMERICHOICE | OTHER | 200001299 | 01 | NJ | AETNA | OTHER | 200001299 | 01 | NJ | UNITED HEALTHCARE | OTHER | MA04898900 | 01 | NJ | STATE LICENSE | OTHER | 200001299 | 01 | NJ | CIGNA | OTHER | 14987 | 01 | NJ | UNIVERSITY HEALTH PLANS | OTHER | 020054424 | 01 | NJ | RAILROAD MC | OTHER | 0683523000 | 01 | NJ | AMERIHEALTH | OTHER |