Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 25MA09990100 | NJ |
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 48775 | MN |
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | 25MA09990100 | NJ |
NPI | 1871501643 |
---|---|
Provider Name | Tom Thomas |
First Address | Boston, MA 02241-6457 |
Second Address | Morristown, NJ 07960-6136 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2006 |
Last Update Date | 19/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
353918000 | (05) | MN |
I60726 | (02) |