Basic Information
| Provider Information | |||||||||
| NPI: | 1053381285 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COLLINS | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 147 MILK ST | ||||||||
| Address2: | PROVIDER ENROLLMENT - 9TH FLOOR | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021094806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6175598104 | ||||||||
| FaxNumber: | 6174213487 | ||||||||
| Practice Location | |||||||||
| Address1: | 16 LANCASTER COUNTY RD | ||||||||
| Address2: | CONCORD HILLSIDE MEDICAL ASSOCIATES | ||||||||
| City: | HARVARD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 014511114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9787726161 | ||||||||
| FaxNumber: | 9787724144 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2006 | ||||||||
| LastUpdateDate: | 05/07/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 49292 | MA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 3083403 | 05 | MA | MEDICAID | J03294 | 01 | MA | BLUE CROSS | OTHER | 4212780 | 01 | MA | AETNA | OTHER | 0379225 | 01 | MA | CIGNA | OTHER | 1205931 | 01 | MA | UNITED HEALTHCARE | OTHER | 700373 | 01 | MA | TUFTS | OTHER | AA48723 | 01 | MA | HARVARD PILGRIM | OTHER |