Basic Information
| Provider Information | |||||||||
| NPI: | 1124056023 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TOM | ||||||||
| FirstName: | ALBERT | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 808 | ||||||||
| Address2: | |||||||||
| City: | NASHUA | ||||||||
| State: | NH | ||||||||
| PostalCode: | 030610808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6035785054 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 168 KINSLEY ST | ||||||||
| Address2: | |||||||||
| City: | NASHUA | ||||||||
| State: | NH | ||||||||
| PostalCode: | 030603634 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6035789363 | ||||||||
| FaxNumber: | 6035789539 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2006 | ||||||||
| LastUpdateDate: | 10/08/2015 | ||||||||
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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 | 207X00000X | 043304 | CT | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | MD429866 | PA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 17285 | NH | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | G920-0142/KDM4CU | 01 | PA | CAREFIRST | OTHER | MD429866 | 01 | PA | LICENSE | OTHER | 120420411 | 01 | PA | DEPT OF LABOR | OTHER | 25-1716306 | 01 | PA | GREATWEST HEALTHCARE | OTHER | 1007307260034 | 01 | PA | MEDICAID GROUP # | OTHER | 1883487 | 01 | PA | HIGHMARK BLUESHIELD | OTHER | 25-1716306 | 01 | PA | DEVON | OTHER | P00841784 | 01 | PA | RAILROAD MEDICARE | OTHER | 25-1716306 | 01 | PA | INTERGROUP | OTHER | 3148288 | 01 | PA | UNITED HEALTH CARE (MAMSI) | OTHER | 50061812 | 01 | PA | CAPITAL BLUECROSS | OTHER | 7413854 | 01 | PA | AETNA NON-HMO | OTHER | 867633 | 01 | PA | MEDICARE GROUP # | OTHER | BT9914145 | 01 | PA | DEA | OTHER | 101705441 0001 | 05 | PA | MEDICAID | 25-1716306 | 01 | PA | MULTIPLAN/PHCS | OTHER | 25-1716306 | 01 | PA | HEALTHNET/TRICARE | OTHER | 7413854 | 01 | PA | AETNA HMO | OTHER |