Provider Demographics
NPI:1609807007
Name:LEBOSQUET, THOMAS P III (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:P
Last Name:LEBOSQUET
Suffix:III
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 1:333 BORTHWICK AVE
Mailing Address - Street 2:EMERGENCY DEPT
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-7128
Mailing Address - Country:US
Mailing Address - Phone:603-433-4012
Mailing Address - Fax:603-433-5184
Practice Address - Street 1:333 BORTHWICK AVE
Practice Address - Street 2:EMERGENCY DEPT
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-7128
Practice Address - Country:US
Practice Address - Phone:603-433-4012
Practice Address - Fax:603-433-5184
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH13217207PE0004X
NC2012-02232207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432341899Medicaid
P00381605OtherRAILROAD MEDICARE
NH30206219Medicaid
NH01Y011074NH01OtherANTHEM
MA2124076Medicaid
P00381605OtherRAILROAD MEDICARE
ME432341899Medicaid