Provider Demographics
NPI:1336278225
Name:EBERT, THOMAS H (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:H
Last Name:EBERT
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 1:18 MALDEN ST
Mailing Address - Street 2:
Mailing Address - City:WEST BOYLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:01583-1019
Mailing Address - Country:US
Mailing Address - Phone:413-233-3025
Mailing Address - Fax:
Practice Address - Street 1:HEALTH NEW ENGLAND
Practice Address - Street 2:ONE MONARCH PLACE
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01144
Practice Address - Country:US
Practice Address - Phone:413-233-3025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA42756207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology