=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053306589
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | THOMAS STEPHEN PEARCE M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/12/2005
-----------------------------------------------------
Last Update Date | 12/01/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 279 E MAIN ST
-----------------------------------------------------
City | GLOUCESTER
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01930-4141
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-282-4600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 279 E MAIN ST
-----------------------------------------------------
City | GLOUCESTER
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01930-4141
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-282-4600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 56285
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------