Provider Demographics
NPI:1972581411
Name:HATHAWAY, THOMAS J (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:HATHAWAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:111 GROSSMAN DR
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-4997
Mailing Address - Country:US
Mailing Address - Phone:781-849-2300
Mailing Address - Fax:781-849-2377
Practice Address - Street 1:111 GROSSMAN DR
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-4997
Practice Address - Country:US
Practice Address - Phone:781-849-2300
Practice Address - Fax:781-849-2377
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA51041208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA051041OtherTUFTS
MA3191460Medicaid
MA0015122OtherNEIGHBORHOOD HEALTH
MAB10459302OtherCIGNA
MAJ12386OtherBLUE CROSS
MAPP137OtherHARVARD PILGRIM
MAJ12386OtherBLUE CROSS
MAJ12386Medicare ID - Type Unspecified