Provider Demographics
NPI:1689658379
Name:BEATTY, THOMAS LEARY
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:LEARY
Last Name:BEATTY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 WASHINGTON ST
Mailing Address - Street 2:SUITE 764
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02462-1628
Mailing Address - Country:US
Mailing Address - Phone:617-965-7800
Mailing Address - Fax:617-965-4581
Practice Address - Street 1:2000 WASHINGTON ST
Practice Address - Street 2:SUITE 764
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02462-1628
Practice Address - Country:US
Practice Address - Phone:617-965-7800
Practice Address - Fax:617-965-4581
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA49875207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
164341OtherHEALTHY START
MAJ04394OtherBCBS
2239716OtherAETNA
B20233801OtherCIGNA
0017072OtherNEIGHBORHOOD HEALTH
13608OtherHPHC
S023506OtherCHAMPUS
0700798OtherUNITED HEALTHCARE
MA049875OtherTUFTS HEALTH PLAN
043200332OtherSTANDARD TAX ID
MA3188795Medicaid
164341OtherHEALTHY START
B20233801OtherCIGNA
J04394Medicare ID - Type Unspecified