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NPI Code Detail

MEDICARE: THOMAS W DORRANCE MSW

MEDICARE: THOMAS W DORRANCE MSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker104907MA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P03088OTHERMABLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1912900424
Entity Type Code : Individual
Provider Name (Legal Business Name) : THOMAS W DORRANCE MSW
Provider Business Mailing Address
First Line : 9 DAMONMILL SQ
Second Line : SUITE 4 A 1
City : CONCORD
State : MA
Zip : 01742-2858
Country : US
Telephone Number : 978-369-6737
Fax Number :
Provider Business Practice Location Address
First Line : 9 DAMONMILL SQ
Second Line : SUITE 4 A 1
City : CONCORD
State : MA
Zip : 01742-2858
Country : US
Telephone Number : 978-369-6737
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/30/2005
Last Update Date : 07/08/2007

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