Provider Demographics
NPI:1932106572
Name:COOPER, THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:COOPER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 WORCESTER ST
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-5420
Mailing Address - Country:US
Mailing Address - Phone:781-431-5255
Mailing Address - Fax:781-431-5329
Practice Address - Street 1:230 WORCESTER ST
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-5420
Practice Address - Country:US
Practice Address - Phone:781-431-5255
Practice Address - Fax:781-431-5329
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA55056207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
055056OtherTUFTS SECURE HORIZONS
27422OtherCHILDREN'S MEDICAL SECURI
J04908OtherBLUE SHIELD INDEMNITY
055056OtherTUFTS
4434OtherHARVARD PILGRIM PPO
B87206OtherFIRST SENIORITY
055056OtherTUFTS BENEFIT ADMIN
055056OtherTUFTS COMMONWELATH
070003328OtherRAILROAD MEDICARE
6692873OtherCIGNA HEALTH CARE
J04908OtherBS-BLUSE CARE ELECT
0016756OtherNEIGHBORHOOD HEALTH PLAN
055056OtherTUFTS TOTAL HEALTH PLAN
4434OtherHARVARD PILGRIM POS
401052OtherHARVARD/PILGRIM
6174167OtherMASS HEALTH
6692873OtherHEALTHSOURCE-MA
J04908OtherHMO BLUE/BLUE CHOICE
6174167OtherMASS HEALTH
B87206OtherFIRST SENIORITY