Provider Demographics
NPI:1740254465
Name:FALDETTA, THOMAS J (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:FALDETTA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:147 MILK ST
Mailing Address - Street 2:PROVIDER ENROLLMENT - 9TH FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-4806
Mailing Address - Country:US
Mailing Address - Phone:617-559-8374
Mailing Address - Fax:
Practice Address - Street 1:291 INDEPENDENCE DR
Practice Address - Street 2:INTERNAL MEDICINE
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-3628
Practice Address - Country:US
Practice Address - Phone:617-541-6505
Practice Address - Fax:617-541-6444
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2011-06-27
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Provider Licenses
StateLicense IDTaxonomies
MA55036207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3062228Medicaid
MA055036OtherTUFTS
MAJ09777OtherBLUE CROSS
MAPM443OtherHARVARD PILGRIM
MAE48015Medicare UPIN
MA055036OtherTUFTS