Provider Demographics
NPI:1487391561
Name:THOMPSON, CHADANE DAVID ROMONE (MB, BS)
Entity type:Individual
Prefix:DR
First Name:CHADANE
Middle Name:DAVID ROMONE
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:MB, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPARTMENT OF MEDICINE
Mailing Address - Street 2:350 ENGLE STREET
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631
Mailing Address - Country:US
Mailing Address - Phone:201-894-3143
Mailing Address - Fax:
Practice Address - Street 1:DEPARTMENT OF MEDICINE
Practice Address - Street 2:350 ENGLE STREET
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631
Practice Address - Country:US
Practice Address - Phone:201-894-3143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-19
Last Update Date:2023-03-20
Deactivation Date:2023-02-17
Deactivation Code:
Reactivation Date:2023-03-20
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program