Provider Demographics
NPI:1437257268
Name:NIGBOROWICZ, THADDEUS J (MD)
Entity Type:Individual
Prefix:
First Name:THADDEUS
Middle Name:J
Last Name:NIGBOROWICZ
Suffix:
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 1:41 MALL RD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01805-0001
Mailing Address - Country:US
Mailing Address - Phone:781-744-8000
Mailing Address - Fax:781-744-5348
Practice Address - Street 1:67 S BEDFORD ST STE 202E
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-5141
Practice Address - Country:US
Practice Address - Phone:781-744-7000
Practice Address - Fax:781-744-5348
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA205726207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0122840Medicaid
MAA31517Medicare PIN
MA0122840Medicaid