Provider Demographics
NPI:1245278027
Name:BOOTH, THOMAS EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:EDWARD
Last Name:BOOTH
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 1:308 CAPSTAN CT
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94065-1024
Mailing Address - Country:US
Mailing Address - Phone:650-868-2846
Mailing Address - Fax:
Practice Address - Street 1:2001 WINWARD WAY STE 101
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94404-2499
Practice Address - Country:US
Practice Address - Phone:650-288-0596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG69034207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC73066Medicare UPIN