Healthcare Provider Details

I. General information

NPI: 1386955144
Provider Name (Legal Business Name): THOMAS R. MAYO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2010
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 REEDSDALE RD
MILTON MA
02186-3926
US

IV. Provider business mailing address

55 WENDELL PARK
MILTON MA
02186-3117
US

V. Phone/Fax

Practice location:
  • Phone: 617-969-4600
  • Fax:
Mailing address:
  • Phone: 617-304-9893
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number259001
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number259001
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: