Healthcare Provider Details

I. General information

NPI: 1194762724
Provider Name (Legal Business Name): THOMAS E SCAMMELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 10/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 LONGWOOD AVE STE 3 HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACO
BOSTON MA
02215-5395
US

IV. Provider business mailing address

79 MAYO RD
WELLESLEY MA
02482-1037
US

V. Phone/Fax

Practice location:
  • Phone: 617-632-7441
  • Fax:
Mailing address:
  • Phone: 617-735-3260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number78378
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number78378
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: