Healthcare Provider Details

I. General information

NPI: 1477931160
Provider Name (Legal Business Name): ROBYN PAULINE THOM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2015
Last Update Date: 03/25/2021
Certification Date: 03/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MAGUIRE RD
LEXINGTON MA
02421-3114
US

IV. Provider business mailing address

1 MAGUIRE RD
LEXINGTON MA
02421-3114
US

V. Phone/Fax

Practice location:
  • Phone: 781-860-1700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number274409
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: