Provider Demographics
NPI:1477543783
Name:SPITZER, THOMAS RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:RICHARD
Last Name:SPITZER
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-0287
Mailing Address - Fax:617-726-2894
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:ZERO EMERSON PLACE SUITE 118
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-724-1124
Practice Address - Fax:617-724-1126
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-27
Last Update Date:2011-09-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA41323207R00000X, 207RH0000X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2056054Medicaid
MAE03012OtherBCBS MA
MA041323OtherTUFTS HEALTH PLAN
MAE03012Medicare ID - Type Unspecified
MA2056054Medicaid