Provider Demographics
NPI:1679566434
Name:CODY, THOMAS P (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:P
Last Name:CODY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:354 MERRIMACK ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01843-1754
Mailing Address - Country:US
Mailing Address - Phone:978-687-2321
Mailing Address - Fax:978-722-7287
Practice Address - Street 1:354 MERRIMACK ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843-1754
Practice Address - Country:US
Practice Address - Phone:978-687-2321
Practice Address - Fax:978-722-7287
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA78935208100000X
NH9108208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA23583OtherFCHP
MA4514539OtherAETNA
MAJ30544OtherBCBSMA
NH0109742Y0MA01OtherANTHEM
MA0003761OtherNHP
MA0747292001OtherCIGNA
MA23-00005OtherUHCNE
MA078935OtherTHP
NH30007008Medicaid
MA3128393Medicaid
MA80534OtherHPHC
NH30007008Medicaid
F80703Medicare UPIN
MA3128393Medicaid