Provider Demographics
NPI:1649430323
Name:SCHUCH, THOMAS J (MD, MPH)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:SCHUCH
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 W BROADWAY
Mailing Address - Street 2:SOUTH BOSTON COMMUNITY HEALTH CENTER
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02127
Mailing Address - Country:US
Mailing Address - Phone:617-269-7500
Mailing Address - Fax:
Practice Address - Street 1:409 W BROADWAY
Practice Address - Street 2:SOUTH BOSTON COMMUNITY HEALTH CENTER
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02127
Practice Address - Country:US
Practice Address - Phone:617-269-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-16
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA235979208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics