Provider Demographics
NPI:1669432621
Name:MARANTZ, THOMAS (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:MARANTZ
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 1:2 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 401
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1270
Mailing Address - Country:US
Mailing Address - Phone:413-781-5735
Mailing Address - Fax:413-732-0225
Practice Address - Street 1:2 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 401
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1270
Practice Address - Country:US
Practice Address - Phone:413-781-5735
Practice Address - Fax:413-732-0225
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA52757207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6179649Medicaid
MAS400190737Medicare PIN
MA6179649Medicaid
MAJ03689Medicare PIN