Basic Information
| Provider Information | |||||||||
| NPI: | 1619964764 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THOMSON | ||||||||
| FirstName: | ANNE | ||||||||
| MiddleName: | JULIA | ||||||||
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| Credential: | RPA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1729 BURRSTONE ROAD | ||||||||
| Address2: | SLOCUM DICKSON MEDICAL GROUP | ||||||||
| City: | NEW HARTFORD | ||||||||
| State: | NY | ||||||||
| PostalCode: | 134131001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3157981661 | ||||||||
| FaxNumber: | 3157981405 | ||||||||
| Practice Location | |||||||||
| Address1: | 1729 BURRSTONE ROAD | ||||||||
| Address2: | |||||||||
| City: | NEW HARTFORD | ||||||||
| State: | NY | ||||||||
| PostalCode: | 13413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3157981661 | ||||||||
| FaxNumber: | 3157981405 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2005 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 007662 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | 02396798 | 05 | NY | MEDICAID |