Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | M0815 | TX |
NPI | 1639139868 |
---|---|
Provider Name | Thomas Aloysius Mcdonald |
First Address | Farmington, CT 06032-2565 |
Second Address | Enfield, CT 06082-3669 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2006 |
Last Update Date | 25/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I33139 | (02) | MA |
P00338922 | (05) | MA |