Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 029483 | CT |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 029483 | CT |
NPI | 1033178496 |
---|---|
Provider Name | Mr. Thomas J Mclarney |
First Address | Middletown, CT 06459-3232 |
Second Address | Middletown, CT 06459-3232 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2006 |
Last Update Date | 31/10/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
004236164 | (05) | CT |
010029483CT04 | BCBS (01) | CT |
294830 | CTC (01) | CT |
F71641 | (02) |