Provider Demographics
NPI:1902800832
Name:FAZIO, THOMAS L (MD)
Entity Type:Individual
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First Name:THOMAS
Middle Name:L
Last Name:FAZIO
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Gender:M
Credentials:MD
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Mailing Address - Street 1:500 MERRIMACK ST
Mailing Address - Street 2:RIVERWALK
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01843-1756
Mailing Address - Country:US
Mailing Address - Phone:978-557-8700
Mailing Address - Fax:978-557-8867
Practice Address - Street 1:500 MERRIMACK ST
Practice Address - Street 2:RIVERWALK
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843-1756
Practice Address - Country:US
Practice Address - Phone:978-557-8700
Practice Address - Fax:978-557-8867
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2013-10-29
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Provider Licenses
StateLicense IDTaxonomies
MA42754207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
3925416OtherCIGNA HEALTHCARE
100014711OtherRAILROAD MEDICARE
0011277OtherNEIGHBORHOOD HEALTH PLAN
678816OtherHEALTHSOURCE
MAD11110OtherBLUE CROSS BLUE SHIELD
30201837OtherNH MEDICAID
975010OtherNETWORK HEALTH
NHA54061OtherANTHEM BLUE CROSS
MA042754OtherTUFTS HEALTH PLAN
MA1902800832OtherFALLON COMMUNITY HEALTH PLAN
MA2060949Medicaid
29-00569OtherEVERCARE
MA4035145OtherAETNA NON HMO
MA1902800832OtherAETNA HMO
MA30259OtherHARVARD PILGRIM HEALTH CA
MA30259OtherHARVARD PILGRIM HEALTH CA
678816OtherHEALTHSOURCE