Provider Demographics
NPI:1568505956
Name:REDNER, THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:REDNER
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:POB 3000-PMB 3066
Mailing Address - Street 2:
Mailing Address - City:WEST TISBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02175
Mailing Address - Country:US
Mailing Address - Phone:617-730-9702
Mailing Address - Fax:
Practice Address - Street 1:6 POST OAK ROAD
Practice Address - Street 2:
Practice Address - City:CHILMARK
Practice Address - State:MA
Practice Address - Zip Code:02535
Practice Address - Country:US
Practice Address - Phone:617-730-9702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA49163207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology