Provider Demographics
NPI:1750301958
Name:MEEHAN, THOMAS PHILLIP SR (MD)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:PHILLIP
Last Name:MEEHAN
Suffix:SR
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 1:120 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810
Mailing Address - Country:US
Mailing Address - Phone:203-743-0100
Mailing Address - Fax:203-731-3116
Practice Address - Street 1:120 MAIN STREET
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810
Practice Address - Country:US
Practice Address - Phone:203-743-0100
Practice Address - Fax:203-731-3116
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT028468207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001284686Medicaid
CT1284686Medicaid
CT110007620Medicare ID - Type Unspecified