Provider Demographics
NPI:1710953898
Name:KLEIN, THOMAS R (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:R
Last Name:KLEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 PLANTATION ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605
Mailing Address - Country:US
Mailing Address - Phone:508-368-3103
Mailing Address - Fax:508-368-3104
Practice Address - Street 1:123 SUMMER ST
Practice Address - Street 2:SUITE 300
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608
Practice Address - Country:US
Practice Address - Phone:508-368-3103
Practice Address - Fax:508-368-3104
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA277030207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0146978Medicaid
AA5967OtherHARVARD PILGRIM HEALTHCAR
0146978OtherHEALTHY START
0146978OtherWELFARE
1000177OtherEVERCARE
042472266OtherONE HEALTH PLAN
4246785OtherAETNA US HEALTHCARE
86726OtherFIRST HEALTH
M04221OtherBLUE CARE ELECT
0082033OtherCIGNA HEALTH PLAN
784043OtherMVP HEALTH CARE
042472266OtherHEALTHCARE VALUE MANAGEME
042472266OtherPRIVATE HEALTHCARE SYSTEM
84413OtherCHILDRENS MEDICAL SECURIT
MO4221OtherMEDICARE B
M04221OtherBLUE SHIELD INDEMNITY
28726OtherFALLON COMMUNITY HEALTH P
M04221OtherBLUE SHIELD HMO BLUE
M04221OtherBLUE CARE ELECT
MAMO4221Medicare ID - Type Unspecified