Provider Demographics
NPI:1750363081
Name:WALSH, THOMAS A (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:A
Last Name:WALSH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 415348
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-5348
Mailing Address - Country:US
Mailing Address - Phone:800-225-8885
Mailing Address - Fax:
Practice Address - Street 1:604 MAIN ST
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:MA
Practice Address - Zip Code:01545-5663
Practice Address - Country:US
Practice Address - Phone:508-842-0057
Practice Address - Fax:508-845-6571
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA44970207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
043058466OtherTRICARE/CHAMPUS
27064OtherCHILDRENS MEDICAL
784245OtherMVP HEALTH CARE
9111503OtherCIGNA HEALTH PLAN
AA1252OtherHARVARD PILGRIM
E33015OtherBLUE SHIELD HMO BLUE
27064OtherHEALTHY START
E33015OtherBLUE SHIELD INDEMNITY
044970OtherTUFTS HEALTH PLAN
4034914OtherAETNA US HEALTHCARE
043058466OtherHEALTHCARE VALUE
1583439OtherFIRST HEALTH
04-3058466OtherTHREE RIVERS
110048770OtherRAILROAD MEDICARE
9900056OtherFALLON COMMUNITY HEALTH
E33015OtherBLUE CARE ELECT
04-00962OtherEVERCARE
04/24/72266OtherPRIVATE HEALTHCARE SYSTEM
AA1252OtherHARVARD PILGRIM
E33015OtherBLUE SHIELD INDEMNITY