Provider Demographics
NPI:1740282680
Name:MEREDITH, THOMAS (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:MEREDITH
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 1:54 WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:NH
Mailing Address - Zip Code:03570-2084
Mailing Address - Country:US
Mailing Address - Phone:603-752-3669
Mailing Address - Fax:603-752-3027
Practice Address - Street 1:59 PAGE HILL RD
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:NH
Practice Address - Zip Code:03570-3531
Practice Address - Country:US
Practice Address - Phone:603-752-2900
Practice Address - Fax:603-752-3727
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH10489208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30200055Medicaid
5830418OtherAETNA GROUP
NH10489OtherSTATE LICENSE#
NH7111690001OtherCIGNA HEALTHCARE
NH7111690001OtherCIGNA HEALTHCARE
NH7111690001OtherCIGNA HEALTHCARE
NH10489OtherSTATE LICENSE#