Basic Information
Provider Information
NPI: 1619300092
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHIN
FirstName: THOMAS
MiddleName: Y
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 280 CHESTNUT ST
Address2: 2ND FL
City: SPRINGFIELD
State: MA
PostalCode: 011991001
CountryCode: US
TelephoneNumber: 4137945700
FaxNumber:  
Practice Location
Address1: 759 CHESTNUT ST
Address2:  
City: SPRINGFIELD
State: MA
PostalCode: 011071619
CountryCode: US
TelephoneNumber: 4137946297
FaxNumber: 4137941767
Other Information
ProviderEnumerationDate: 08/20/2013
LastUpdateDate: 12/21/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208M00000X266364MAN Allopathic & Osteopathic PhysiciansHospitalist 
207R00000X266364MAY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


Home