Provider Demographics
NPI:1285662627
Name:CHERRY, THOMAS C JR (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:C
Last Name:CHERRY
Suffix:JR
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 1:112 LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-2737
Mailing Address - Country:US
Mailing Address - Phone:860-425-8701
Mailing Address - Fax:860-425-8707
Practice Address - Street 1:330 WASHINGTON ST
Practice Address - Street 2:SUITE 410
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2700
Practice Address - Country:US
Practice Address - Phone:860-425-5300
Practice Address - Fax:860-425-5301
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0243762086S0105X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0080123210Medicaid
CT3V6188OtherHEALTHNET
CTP4093027OtherOXFORD
CT010024376CT01OtherANTHEM
CTD400009454Medicare PIN