1093082810 NPI number — THOMAS A. MORRIS, M.D.

Table of content: (NPI 1093082810)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093082810 NPI number — THOMAS A. MORRIS, M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THOMAS A. MORRIS, M.D.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093082810
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/22/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
51 LIBBY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROCKTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02302-2949
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-587-6060
Provider Business Mailing Address Fax Number:
508-588-0678

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
51 LIBBY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROCKTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02302-2949
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-587-6060
Provider Business Practice Location Address Fax Number:
508-588-0678
Provider Enumeration Date:
11/22/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MORRIS
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
PROPRIETOR
Authorized Official Telephone Number:
508-587-6060

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X , with the licence number:  49635 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1083724553 . This is a "TYPE 1 NPI" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 110063893/A , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".