Provider Demographics
NPI:1831157346
Name:CONDON, THOMAS J (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:CONDON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:630 PLANTATION ST
Mailing Address - Street 2:WOT 12TH FLOOR ATTN PHYSICIAN SERVICES
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605
Mailing Address - Country:US
Mailing Address - Phone:508-368-5529
Mailing Address - Fax:508-368-5530
Practice Address - Street 1:135 GOLD STAR BLVD
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01606
Practice Address - Country:US
Practice Address - Phone:508-856-9599
Practice Address - Fax:508-854-4997
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MA30422207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
26726OtherHEALTHY START
3099725OtherWELFARE
MA3099725Medicaid
917608OtherFIRST HEALTH
AA3296OtherHARVARD PILGRIM HEALTHCAR
9900030OtherFALLON COMMUNITY HEALTH
0800301OtherEVERCARE
5245190OtherAETNA US HEALTHCARE
N01518OtherBLUE SHIELD INDEMNITY
N01518OtherBLUE CARE ELECT
26726OtherCHILDRENS MEDICAL SECURIT
35481129OtherCIGNA HEALTH PLAN
N01518OtherBLUE SHIELD HMO BLUE
784011OtherMVP HEALTH CARE
3099725OtherWELFARE
917608OtherFIRST HEALTH
MAN01518Medicare ID - Type Unspecified