Provider Demographics
NPI:1184605354
Name:MACGILLIVRAY, THOMAS (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:MACGILLIVRAY
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 1:6550 FANNIN ST
Mailing Address - Street 2:SUITE 1401
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2717
Mailing Address - Country:US
Mailing Address - Phone:713-441-5200
Mailing Address - Fax:713-793-7428
Practice Address - Street 1:6550 FANNIN ST
Practice Address - Street 2:SUITE 1401
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2717
Practice Address - Country:US
Practice Address - Phone:713-441-5200
Practice Address - Fax:713-793-7428
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA150690208G00000X
TXR0065208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3175014Medicaid
MA775509OtherTUFTS HEALTH PLAN
TX8GF597OtherBCBS
MAJ18438OtherBCBS MA
TX548306ZSWDMedicare PIN
TX8GF597OtherBCBS