Provider Demographics
NPI:1366975443
Name:THOMPSON, VIVIAN ASAKOMA (MD)
Entity type:Individual
Prefix:DR
First Name:VIVIAN
Middle Name:ASAKOMA
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:VIVIAN
Other - Middle Name:
Other - Last Name:ASAKOMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:53 COLUMBIA STREET
Mailing Address - Street 2:
Mailing Address - City:RENSSELAER
Mailing Address - State:NY
Mailing Address - Zip Code:12144
Mailing Address - Country:US
Mailing Address - Phone:518-434-2526
Mailing Address - Fax:518-434-2595
Practice Address - Street 1:53 COLUMBIA STREET
Practice Address - Street 2:
Practice Address - City:RENSSELAER
Practice Address - State:NY
Practice Address - Zip Code:12144
Practice Address - Country:US
Practice Address - Phone:518-434-2526
Practice Address - Fax:518-434-2595
Is Sole Proprietor?:No
Enumeration Date:2017-04-06
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY310986207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine