Provider Demographics
NPI:1699815910
Name:PSYCHIATRIC ASSOCIATES OF MALDEN, P.C.
Entity Type:Organization
Organization Name:PSYCHIATRIC ASSOCIATES OF MALDEN, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:CANNON
Authorized Official - Last Name:BOND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-397-6789
Mailing Address - Street 1:578 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-3900
Mailing Address - Country:US
Mailing Address - Phone:781-397-6789
Mailing Address - Fax:781-397-2597
Practice Address - Street 1:578 MAIN ST
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-3900
Practice Address - Country:US
Practice Address - Phone:781-397-6789
Practice Address - Fax:781-397-2597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA372332084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM10614OtherBLUE CROSS
MA724596OtherTUFTS
MA9767851Medicaid
MAM10614OtherBLUE CROSS