Provider Demographics
NPI:1982695664
Name:RUENGER, THOMAS M (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:M
Last Name:RUENGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:LAHEY HOSPITAL & MEDICAL CENTER
Mailing Address - Street 2:41 MALL ROAD
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01805-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:LAHEY HOSPITAL & MEDICAL CENTER
Practice Address - Street 2:67 S. BEDFORD STREET
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01805-5108
Practice Address - Country:US
Practice Address - Phone:781-744-5115
Practice Address - Fax:781-744-5687
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA211249207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110061088AMedicaid
H07769Medicare UPIN
MAA2918901Medicare PIN