Provider Demographics
NPI:1669455192
Name:THURSBY, MICHAEL A (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:THURSBY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 WATERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914-3525
Mailing Address - Country:US
Mailing Address - Phone:401-438-5950
Mailing Address - Fax:401-435-2245
Practice Address - Street 1:318 WATERMAN AVE
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914
Practice Address - Country:US
Practice Address - Phone:401-438-5950
Practice Address - Fax:401-435-6700
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA213316207RN0300X
RI00502207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110005090AMedicaid
110231848OtherRAILROAD MEDI
RI405620OtherBLUE CHIP
RI9022203Medicaid
MA000000037167OtherBOSTON MEDICAL
459232OtherTUFTS
692775OtherHARVARD PILGRIM
3100290OtherUNITED
MAJ25258OtherBLUE CROSS
RI502OtherBLUE CROSS
7484643OtherAETNA
1305389001OtherCIGNA
4132OtherNEIGHBORHOOD HLT
459232OtherTUFTS
4132OtherNEIGHBORHOOD HLT
3100290OtherUNITED