Provider Demographics
NPI:1124043500
Name:JACKSON, THOMAS LANE (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:LANE
Last Name:JACKSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:246 PLEASANT ST STE G2
Mailing Address - Street 2:CONCORD HOSPITAL CENTER FOR UROLOGIC CARE
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-2548
Mailing Address - Country:US
Mailing Address - Phone:603-224-3388
Mailing Address - Fax:603-225-3557
Practice Address - Street 1:246 PLEASANT ST STE G2
Practice Address - Street 2:CONCORD HOSPITAL CENTER FOR UROLOGIC CARE
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-2548
Practice Address - Country:US
Practice Address - Phone:603-224-3388
Practice Address - Fax:603-225-3557
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2009-06-18
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Provider Licenses
StateLicense IDTaxonomies
NH13825208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology