Provider Demographics
NPI:1609838218
Name:KNOX, THOMAS I (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:I
Last Name:KNOX
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 1:345 N MAIN ST FL 1
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06117-2515
Mailing Address - Country:US
Mailing Address - Phone:860-547-1489
Mailing Address - Fax:860-548-9105
Practice Address - Street 1:345 N MAIN ST FL 1
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06117-2515
Practice Address - Country:US
Practice Address - Phone:860-547-1489
Practice Address - Fax:860-548-9105
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT037021174400000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
2858165OtherAETNA
CT010037021CT01OtherBLUE SHIELD
2539791002OtherCIGNA
CT037021OtherCONNECTICARE
2671151OtherOXFORD
CT001370212Medicaid
2V5481OtherHEALTHNET
2539791002OtherCIGNA
2V5481OtherHEALTHNET