Healthcare Provider Details

I. General information

NPI: 1356314983
Provider Name (Legal Business Name): ROBERT JOSEPH THOMAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 08/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 BROOKLINE AVE KB 23
BOSTON MA
02215-5400
US

IV. Provider business mailing address

330 BROOKLINE AVE KB 23
BOSTON MA
02215-5400
US

V. Phone/Fax

Practice location:
  • Phone: 617-667-5864
  • Fax: 617-667-4849
Mailing address:
  • Phone: 617-667-5864
  • Fax: 617-667-4849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number150323
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: