1982692794 NPI number — THOMAS E VERDONE M.D.

Table of content: THOMAS E VERDONE M.D. (NPI 1982692794)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982692794 NPI number — THOMAS E VERDONE M.D.

Organization/Personal Information

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

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:
1982692794
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/19/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 417297
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02241-7297
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-623-3869
Provider Business Mailing Address Fax Number:
302-709-2402

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 GOOSE LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GUILFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06437-5101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-453-7100
Provider Business Practice Location Address Fax Number:
203-453-7810
Provider Enumeration Date:
10/06/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  031489 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207L00000X , with the licence number: 031489 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 001314898 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




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