Healthcare Provider Details

I. General information

NPI: 1538691142
Provider Name (Legal Business Name): THOMAS ADAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2017
Last Update Date: 09/28/2021
Certification Date: 09/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1493 CAMBRIDGE ST
CAMBRIDGE MA
02139-1047
US

IV. Provider business mailing address

1493 CAMBRIDGE ST
CAMBRIDGE MA
02139-1047
US

V. Phone/Fax

Practice location:
  • Phone: 617-655-1000
  • Fax:
Mailing address:
  • Phone: 617-655-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number281924
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: