Provider Demographics
NPI:1902978919
Name:THOMPSON, RUPERT ANTHONY (MD)
Entity Type:Individual
Prefix:
First Name:RUPERT
Middle Name:ANTHONY
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 330238
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11233
Mailing Address - Country:US
Mailing Address - Phone:917-751-3550
Mailing Address - Fax:718-709-7023
Practice Address - Street 1:374 STOCKHOLM ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11237-4006
Practice Address - Country:US
Practice Address - Phone:718-521-1056
Practice Address - Fax:718-521-1104
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY186206208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG89982Medicare UPIN