Healthcare Provider Details

I. General information

NPI: 1972593648
Provider Name (Legal Business Name): THOMAS CANNON BOND M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 03/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

578 MAIN ST
MALDEN MA
02148-3900
US

IV. Provider business mailing address

578 MAIN ST
MALDEN MA
02148-3900
US

V. Phone/Fax

Practice location:
  • Phone: 781-397-6789
  • Fax: 781-397-2597
Mailing address:
  • Phone: 781-397-6789
  • Fax: 781-397-2597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number037233
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number037233
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: