Provider Demographics
NPI:1760758726
Name:THORNTON, AMANDA VIRGINIA HEYWOOD (MD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:VIRGINIA HEYWOOD
Last Name:THORNTON
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Gender:F
Credentials:MD
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Mailing Address - Street 1:1 BOSTON MEDICAL CTR PL
Mailing Address - Street 2:DOWLING 3 NORTH
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2908
Mailing Address - Country:US
Mailing Address - Phone:617-414-3779
Mailing Address - Fax:617-414-7062
Practice Address - Street 1:1 BOSTON MEDICAL CTR PL
Practice Address - Street 2:DOWLING 3 NORTH
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2908
Practice Address - Country:US
Practice Address - Phone:617-414-3779
Practice Address - Fax:617-414-7062
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-23
Last Update Date:2022-02-11
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Provider Licenses
StateLicense IDTaxonomies
CAA120230207R00000X
MA255112207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty