Provider Demographics
NPI:1245265701
Name:JAVERY, THOMAS EDWARD (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:EDWARD
Last Name:JAVERY
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 1:5 S GROVE ST
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01835-7517
Mailing Address - Country:US
Mailing Address - Phone:978-374-0760
Mailing Address - Fax:978-374-0760
Practice Address - Street 1:35 CONGRESS ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-5529
Practice Address - Country:US
Practice Address - Phone:678-825-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA220960207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2079020Medicaid
MA412043OtherTUFTS HEALTH PLAN
MAJ27629OtherBLUE CROSS & BLUE SHIELD
MAJ27629OtherBLUE CROSS & BLUE SHIELD
MAA36949Medicare ID - Type Unspecified