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NPI Code Detail

MEDICARE: THOMAS BOULDING PA-C

MEDICARE: THOMAS BOULDING PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant5087CT

General Provider Information

NPI Number : 1083243927
Entity Type Code : Individual
Provider Name (Legal Business Name) : THOMAS BOULDING PA-C
Provider Business Mailing Address
First Line : 521 BOSTON POST RD
Second Line :
City : ORANGE
State : CT
Zip : 06477-3506
Country : US
Telephone Number : 305-978-4342
Fax Number :
Provider Business Practice Location Address
First Line : 315 MARTIN LUTHER KING JR WAY
Second Line :
City : TACOMA
State : WA
Zip : 98405-4234
Country : US
Telephone Number : 305-978-4342
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/03/2020
Last Update Date : 12/31/2025

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Directions to “ THOMAS BOULDING PA-C” Practice Location

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