Provider Demographics
NPI:1013074681
Name:JAQUITH-HOUSTON, THOMAS E (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:E
Last Name:JAQUITH-HOUSTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 BROTHERTON WAY
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01501-2684
Mailing Address - Country:US
Mailing Address - Phone:508-721-1199
Mailing Address - Fax:508-453-8019
Practice Address - Street 1:4 BROTHERTON WAY
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:MA
Practice Address - Zip Code:01501-2684
Practice Address - Country:US
Practice Address - Phone:508-721-1199
Practice Address - Fax:508-453-8019
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA235434207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine