Provider Demographics
NPI:1487793220
Name:THOMSON, PAUL EUGENE (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:EUGENE
Last Name:THOMSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5420 HAFT RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45247-7422
Mailing Address - Country:US
Mailing Address - Phone:513-574-7174
Mailing Address - Fax:513-574-7174
Practice Address - Street 1:425 HOME ST
Practice Address - Street 2:BCGH OUTPATIENT PAVILION
Practice Address - City:GEORGETOWN
Practice Address - State:OH
Practice Address - Zip Code:45121
Practice Address - Country:US
Practice Address - Phone:937-378-7676
Practice Address - Fax:937-378-7688
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35055353207R00000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0706552Medicaid
A17501Medicare UPIN
OH0618063Medicare PIN