Provider Demographics
NPI:1902828072
Name:THOMPSON, DEBORAH J (PA)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:J
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ON TAP HEALTH
Mailing Address - Street 2:401 WATERFLOWER CIRCLE SUITE 201
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446
Mailing Address - Country:US
Mailing Address - Phone:802-698-8583
Mailing Address - Fax:833-388-1974
Practice Address - Street 1:ON TAP HEALTH
Practice Address - Street 2:401 WATERFLOWER CIRCLE SUITE 201
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446
Practice Address - Country:US
Practice Address - Phone:802-698-8583
Practice Address - Fax:833-388-1974
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0550030453363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0AP1189Medicaid
VT0AP1189Medicaid
VTTHAP1189Medicare ID - Type Unspecified