Provider Demographics
NPI:1124056023
Name:TOM, ALBERT (MD)
Entity type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:
Last Name:TOM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 808
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03061-0808
Mailing Address - Country:US
Mailing Address - Phone:603-578-5054
Mailing Address - Fax:
Practice Address - Street 1:168 KINSLEY ST
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-3634
Practice Address - Country:US
Practice Address - Phone:603-578-9363
Practice Address - Fax:603-578-9539
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT043304207X00000X
PAMD429866207X00000X
NH17285207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAG920-0142/KDM4CUOtherCAREFIRST
PAMD429866OtherLICENSE
PA120420411OtherDEPT OF LABOR
PA25-1716306OtherGREATWEST HEALTHCARE
PA1007307260034OtherMEDICAID GROUP #
PA1883487OtherHIGHMARK BLUESHIELD
PA25-1716306OtherDEVON
PAP00841784OtherRAILROAD MEDICARE
PA25-1716306OtherINTERGROUP
PA3148288OtherUNITED HEALTH CARE (MAMSI)
PA50061812OtherCAPITAL BLUECROSS
PA7413854OtherAETNA NON-HMO
PA867633OtherMEDICARE GROUP #
PA101705441 0001Medicaid
PA25-1716306OtherMULTIPLAN/PHCS
PA25-1716306OtherHEALTHNET/TRICARE
PA7413854OtherAETNA HMO
PA7413854OtherAETNA HMO
PA7413854OtherAETNA NON-HMO
PA867633OtherMEDICARE GROUP #