Provider Demographics
NPI:1922101294
Name:O'HALLORAN, THOMAS DAVID (MB BCH BAO)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:DAVID
Last Name:O'HALLORAN
Suffix:
Gender:M
Credentials:MB BCH BAO
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Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:33 PARKER ST
Mailing Address - Street 2:APT. 2
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-2230
Mailing Address - Country:US
Mailing Address - Phone:617-661-9010
Mailing Address - Fax:
Practice Address - Street 1:BETH ISRAEL DEACONESS MEDICAL CENTER, 1 DEACONESS ROAD
Practice Address - Street 2:DIVISION OF CARDIOLOGY
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215
Practice Address - Country:US
Practice Address - Phone:617-632-7828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA219608207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease