Healthcare Provider Details

I. General information

NPI: 1063419398
Provider Name (Legal Business Name): THOMAS CAUGHEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 11/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MOUNT AUBURN ST HEMA/ONC
CAMBRIDGE MA
02138
US

IV. Provider business mailing address

300 MOUNT AUBURN ST HEMA/ONC
CAMBRIDGE MA
02138
US

V. Phone/Fax

Practice location:
  • Phone: 617-497-9646
  • Fax: 617-499-5464
Mailing address:
  • Phone: 617-497-9646
  • Fax: 617-499-5464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number210442
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: