Provider Demographics
NPI:1497719033
Name:AMOROSO, THOMAS A (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:A
Last Name:AMOROSO
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 1:705 MOUNT AUBURN ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-1508
Mailing Address - Country:US
Mailing Address - Phone:617-972-9400
Mailing Address - Fax:
Practice Address - Street 1:109 STONE ROOT LN
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-4700
Practice Address - Country:US
Practice Address - Phone:617-785-8857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA74344207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA000000047345OtherBMC HEALTHNET
MA074344OtherTUFTS
MAAA101486OtherPILGRAM HEALTH
MAJ11352OtherBS
MA3084663Medicaid
MA000000047345OtherBMC HEALTHNET
MAJ1135201Medicare PIN