Provider Demographics
NPI:1891740858
Name:THOMASON, PHILIP A (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:A
Last Name:THOMASON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2527 CRANBERRY HIGHWAY
Mailing Address - Street 2:ATTN: PROVIDER RELATIONS DEPT.
Mailing Address - City:WAREHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02571-1046
Mailing Address - Country:US
Mailing Address - Phone:800-841-5200
Mailing Address - Fax:508-273-1241
Practice Address - Street 1:85 HERRICK ST
Practice Address - Street 2:RADIOLOGY DEPARTMENT
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-1776
Practice Address - Country:US
Practice Address - Phone:978-927-6385
Practice Address - Fax:978-921-7011
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA0525552085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6182577Medicaid
B74504Medicare UPIN
MA6182577Medicaid