Provider Demographics
NPI:1609884519
Name:THORNLEY, IAN JAMES (MB BS)
Entity Type:Individual
Prefix:DR
First Name:IAN
Middle Name:JAMES
Last Name:THORNLEY
Suffix:
Gender:M
Credentials:MB BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:27 CAMDEN ROAD
Mailing Address - Street 2:
Mailing Address - City:AUBURNDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02466
Mailing Address - Country:US
Mailing Address - Phone:617-244-5248
Mailing Address - Fax:617-244-5248
Practice Address - Street 1:57 HIGHLAND AVE
Practice Address - Street 2:NORTH SHORE CHILDRENS HOSPITAL PEDIATRIC EMERGENCY ROOM
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970
Practice Address - Country:US
Practice Address - Phone:978-354-2750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA215122207PP0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0175587Medicaid
H67427Medicare UPIN
MA0175587Medicaid