Provider Demographics
NPI:1275504862
Name:STINSON, THOMAS WILDER III (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:WILDER
Last Name:STINSON
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:400 W CUMMINGS PARK
Mailing Address - Street 2:SUITE 1825
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-6519
Mailing Address - Country:US
Mailing Address - Phone:781-820-9732
Mailing Address - Fax:781-989-9396
Practice Address - Street 1:400 W CUMMINGS PARK
Practice Address - Street 2:STE 1825
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-6519
Practice Address - Country:US
Practice Address - Phone:781-820-9732
Practice Address - Fax:781-989-9396
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-31
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA39897207LP2900X, 207LA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LA0401XAllopathic & Osteopathic PhysiciansAnesthesiologyAddiction Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6184456Medicaid
MAAA17224OtherHARVARD PILGRIM HEALTH
050031023OtherRAILROAD MEDICARE-GBA PAL
MA039897OtherTUFTS ASSOC. HEALTH PLANS
NH30201011Medicaid
MA992959OtherNETWORK HEALTH
MAJ03510OtherBLUE CROSS & BLUE SHIELD
MA6184456Medicaid
J03510Medicare ID - Type Unspecified