Provider Demographics
NPI:1295844207
Name:GAZIANO, THOMAS ANDREW (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:ANDREW
Last Name:GAZIANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1620 TREMONT STREET
Mailing Address - Street 2:BRIGHAM AND WOMENS HOSPITAL SMHI DIVISION
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02120
Mailing Address - Country:US
Mailing Address - Phone:617-983-4100
Mailing Address - Fax:
Practice Address - Street 1:640 CENTRE STREET
Practice Address - Street 2:SOUTHERN JAMAICA PLAIN HEALTH CENTER
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130
Practice Address - Country:US
Practice Address - Phone:617-983-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA156367207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease