Provider Demographics
NPI:1003891219
Name:BOND, THOMAS W (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:W
Last Name:BOND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11109 PARKVIEW PLAZA DR # 117
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1331 MINNICH RD
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:IN
Practice Address - Zip Code:46774-2051
Practice Address - Country:US
Practice Address - Phone:260-425-5000
Practice Address - Fax:260-425-5048
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01047495A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000111945OtherANTHEM
00001891442 02OtherUNITED HEALTHCARE
IN080130063OtherRAILROAD MEDICARE
IN200177810Medicaid
5704611OtherAETNA
IN9597OtherPHYSICIANS HEALTH PLAN
5704611OtherAETNA
00001891442 02OtherUNITED HEALTHCARE
IN200177810Medicaid
IN069860RMedicare PIN