Provider Demographics
NPI:1386628279
Name:THAYER, JOHN ADAM (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ADAM
Last Name:THAYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:501 SOUTHAMPTON RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:WESTFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01085-1592
Mailing Address - Country:US
Mailing Address - Phone:413-572-3000
Mailing Address - Fax:413-572-3033
Practice Address - Street 1:501 SOUTHAMPTON RD
Practice Address - Street 2:SUITE D
Practice Address - City:WESTFIELD
Practice Address - State:MA
Practice Address - Zip Code:01085-1592
Practice Address - Country:US
Practice Address - Phone:413-572-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-03
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA155865207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ18741OtherBCBS OF MA ID
MA3178307Medicaid
MAJ18741OtherBCBS OF MA ID
G65698Medicare UPIN