Provider Demographics
NPI:1558953315
Name:SMITH, THOMAS B (RN)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:B
Last Name:SMITH
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 CEDAR FARM RD
Mailing Address - Street 2:
Mailing Address - City:MEDWAY
Mailing Address - State:MA
Mailing Address - Zip Code:02053-6206
Mailing Address - Country:US
Mailing Address - Phone:857-523-0516
Mailing Address - Fax:
Practice Address - Street 1:50 CEDAR FARM RD
Practice Address - Street 2:
Practice Address - City:MEDWAY
Practice Address - State:MA
Practice Address - Zip Code:02053-6206
Practice Address - Country:US
Practice Address - Phone:857-523-0516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2267459163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator