Basic Information
| Provider Information | |||||||||
| NPI: | 1750874871 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THOMPSON | ||||||||
| FirstName: | JARED | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | YORK | ||||||||
| State: | ME | ||||||||
| PostalCode: | 039091099 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2073512478 | ||||||||
| FaxNumber: | 2073512216 | ||||||||
| Practice Location | |||||||||
| Address1: | 343 US ROUTE 1 | ||||||||
| Address2: | |||||||||
| City: | YORK | ||||||||
| State: | ME | ||||||||
| PostalCode: | 039091636 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2073512600 | ||||||||
| FaxNumber: | 2073512601 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2018 | ||||||||
| LastUpdateDate: | 06/16/2018 | ||||||||
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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 | 363A00000X | PA1824 | ME | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363AS0400X | ME | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
ID Information
| ID | Type | State | Issuer | Description | PA1824 | 01 | ME | LICENSE | OTHER |