Basic Information
| Provider Information | |||||||||
| NPI: | 1184643546 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCOTT | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 74 PLEASANT ST | ||||||||
| Address2: | STE 204 | ||||||||
| City: | NEW LONDON | ||||||||
| State: | NH | ||||||||
| PostalCode: | 032575881 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6034212220 | ||||||||
| FaxNumber: | 6034212223 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 PARKLAND DR | ||||||||
| Address2: | |||||||||
| City: | DERRY | ||||||||
| State: | NH | ||||||||
| PostalCode: | 030382746 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6034212220 | ||||||||
| FaxNumber: | 6034212223 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2006 | ||||||||
| LastUpdateDate: | 01/10/2017 | ||||||||
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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 | 207P00000X | 11677 | NH | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 44290 | 01 | HARVARD PILGRIM | OTHER | 458293 | 01 | TUFTS | OTHER | 7998178 | 01 | AETNA | OTHER | 42682 | 01 | BMC HEALTHNET PLAN | OTHER | 7998178 | 01 | NH | AETNA | OTHER | P00182391 | 01 | RAILROAD MEDICARE | OTHER | 04Y003855NH02 | 01 | NH | ANTHEM | OTHER | 30222186 | 05 | NH | MEDICAID | 2093120 | 05 | MA | MEDICAID |