Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | L-224528 | MA |
N | 111NI0900X | Internist | L-224528 | MA |
Y | 207RG0100X | Gastroenterologist | 049594 | CT |
N | 207RG0100X | Gastroenterologist | 247343-1 | NY |
NPI | 1013043850 |
---|---|
Provider Name | Jennifer Su Thompson |
First Address | Hamden, CT 06518-3691 |
Second Address | Hamden, CT 06518-3691 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2007 |
Last Update Date | 17/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1013043850 | (05) | CT |