Basic Information
| Provider Information | |||||||||
| NPI: | 1619964731 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THOMPSON | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1259 S CEDAR CREST BLVD | ||||||||
| Address2: | STE 100 | ||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 18103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104374134 | ||||||||
| FaxNumber: | 6107700993 | ||||||||
| Practice Location | |||||||||
| Address1: | 1259 S CEDAR CREST BLVD | ||||||||
| Address2: | STE 100 | ||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 18103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104374134 | ||||||||
| FaxNumber: | 6107700993 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2005 | ||||||||
| LastUpdateDate: | 09/06/2007 | ||||||||
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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 | 207N00000X | MD028651E | PA | N | Allopathic & Osteopathic Physicians | Dermatology | 207NS0135X | MD028651E | PA | Y | Allopathic & Osteopathic Physicians | Dermatology | Procedural Dermatology |
ID Information
| ID | Type | State | Issuer | Description | 172424 | 01 | PA | HIGHMARK | OTHER | 02343000 | 01 | PA | CAPITAL BLUE CROSS | OTHER |