Provider Demographics
NPI:1437133386
Name:PAPPAVASELIO, THOMAS P (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:P
Last Name:PAPPAVASELIO
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:360 MERRIMACK ST
Mailing Address - Street 2:BLDG 9, ENTRANCE I
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01843-1740
Mailing Address - Country:US
Mailing Address - Phone:978-688-6182
Mailing Address - Fax:978-689-0731
Practice Address - Street 1:360 MERRIMACK ST
Practice Address - Street 2:BLDG 9, ENTRANCE I
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843-1740
Practice Address - Country:US
Practice Address - Phone:978-688-6185
Practice Address - Fax:978-689-0731
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2016-08-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA50238207W00000X
NH9113207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110056804AMedicaid
NH3091267Medicaid
NHRE4382Medicare ID - Type Unspecified
MAJ04228Medicare ID - Type Unspecified