Provider Demographics
NPI:1376625061
Name:MCDOWELL, THOMAS (PAC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:MCDOWELL
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 CAREW ST
Mailing Address - Street 2:STE 300
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104-2478
Mailing Address - Country:US
Mailing Address - Phone:413-781-2211
Mailing Address - Fax:
Practice Address - Street 1:300 CAREW ST
Practice Address - Street 2:SUITE 1
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-2485
Practice Address - Country:US
Practice Address - Phone:413-781-2211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1143363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP04003Medicare UPIN
MAAP1243Medicare ID - Type Unspecified