Healthcare Provider Details

I. General information

NPI: 1275504862
Provider Name (Legal Business Name): THOMAS WILDER STINSON III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 03/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W CUMMINGS PARK STE 1825
WOBURN MA
01801-6519
US

IV. Provider business mailing address

400 W CUMMINGS PARK SUITE 1825
WOBURN MA
01801-6519
US

V. Phone/Fax

Practice location:
  • Phone: 781-820-9732
  • Fax: 781-989-9396
Mailing address:
  • Phone: 781-820-9732
  • Fax: 781-989-9396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number39897
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207LA0401X
TaxonomyAddiction Medicine (Anesthesiology) Physician
License Number39897
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: