Provider Demographics
NPI:1568447480
Name:THOMAS, BABATUNDE O (MD)
Entity Type:Individual
Prefix:
First Name:BABATUNDE
Middle Name:O
Last Name:THOMAS
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 1:326 NICHOLS RD
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01420-1914
Mailing Address - Country:US
Mailing Address - Phone:978-878-8100
Mailing Address - Fax:978-878-8418
Practice Address - Street 1:14 MANNING AVENUE
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453
Practice Address - Country:US
Practice Address - Phone:978-847-0110
Practice Address - Fax:978-847-0112
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-14
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA220906207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2100509Medicaid
MAA3819902Medicare PIN
MA2100509Medicaid
MAA38199Medicare ID - Type Unspecified