Provider Demographics
NPI:1639139868
Name:MCDONALD, THOMAS ALOYSIUS (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:ALOYSIUS
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:74 BATTERSON PARK RD STE 107
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-2565
Mailing Address - Country:US
Mailing Address - Phone:860-549-8276
Mailing Address - Fax:860-244-1075
Practice Address - Street 1:7 ELM ST FL 3
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-3669
Practice Address - Country:US
Practice Address - Phone:413-785-4666
Practice Address - Fax:413-846-4756
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0815207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP00338922Medicaid
MAP00338922Medicaid
MAI33139Medicare UPIN