Provider Demographics
NPI:1568543429
Name:THOMAS, MATHEW (MD)
Entity Type:Individual
Prefix:
First Name:MATHEW
Middle Name:
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 1:240 EAST ST
Mailing Address - Street 2:
Mailing Address - City:PLAINVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06062
Mailing Address - Country:US
Mailing Address - Phone:860-747-4541
Mailing Address - Fax:860-793-1218
Practice Address - Street 1:240 EAST ST
Practice Address - Street 2:
Practice Address - City:PLAINVILLE
Practice Address - State:CT
Practice Address - Zip Code:06062
Practice Address - Country:US
Practice Address - Phone:860-747-4541
Practice Address - Fax:860-793-1218
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT031734207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C01397Medicare ID - Type Unspecified
729964Medicare UPIN