Provider Demographics
NPI:1053381285
Name:COLLINS, THOMAS M (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:M
Last Name:COLLINS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:147 MILK ST
Mailing Address - Street 2:PROVIDER ENROLLMENT - 9TH FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-4806
Mailing Address - Country:US
Mailing Address - Phone:617-559-8104
Mailing Address - Fax:617-421-3487
Practice Address - Street 1:16 LANCASTER COUNTY RD
Practice Address - Street 2:CONCORD HILLSIDE MEDICAL ASSOCIATES
Practice Address - City:HARVARD
Practice Address - State:MA
Practice Address - Zip Code:01451-1114
Practice Address - Country:US
Practice Address - Phone:978-772-6161
Practice Address - Fax:978-772-4144
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2009-05-07
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Provider Licenses
StateLicense IDTaxonomies
MA49292208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3083403Medicaid
MAJ03294OtherBLUE CROSS
MA4212780OtherAETNA
MA0379225OtherCIGNA
MA1205931OtherUNITED HEALTHCARE
MA700373OtherTUFTS
MAAA48723OtherHARVARD PILGRIM
MA3083403Medicaid