Healthcare Provider Details

I. General information

NPI: 1114925211
Provider Name (Legal Business Name): THOMAS D SHIPP MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 05/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BROOKLINE PL SUITE 506
BROOKLINE MA
02445-7224
US

IV. Provider business mailing address

340 MAIN ST STE 670
WORCESTER MA
01608-1604
US

V. Phone/Fax

Practice location:
  • Phone: 617-739-0245
  • Fax: 617-738-6703
Mailing address:
  • Phone: 508-754-3566
  • Fax: 508-438-6368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number77466
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number77466
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number77466
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: