Basic Information
| Provider Information | |||||||||
| NPI: | 1710953898 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KLEIN | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 630 PLANTATION ST | ||||||||
| Address2: | |||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5083683103 | ||||||||
| FaxNumber: | 5083683104 | ||||||||
| Practice Location | |||||||||
| Address1: | 123 SUMMER ST | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5083683103 | ||||||||
| FaxNumber: | 5083683104 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2006 | ||||||||
| LastUpdateDate: | 02/18/2009 | ||||||||
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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 | 207Y00000X | 277030 | MA | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 0146978 | 05 | MA | MEDICAID | AA5967 | 01 | HARVARD PILGRIM HEALTHCAR | OTHER | 0146978 | 01 | HEALTHY START | OTHER | 0146978 | 01 | WELFARE | OTHER | 1000177 | 01 | EVERCARE | OTHER | 042472266 | 01 | ONE HEALTH PLAN | OTHER | 4246785 | 01 | AETNA US HEALTHCARE | OTHER | 86726 | 01 | FIRST HEALTH | OTHER | M04221 | 01 | BLUE CARE ELECT | OTHER | 0082033 | 01 | CIGNA HEALTH PLAN | OTHER | 784043 | 01 | MVP HEALTH CARE | OTHER | 042472266 | 01 | HEALTHCARE VALUE MANAGEME | OTHER | 042472266 | 01 | PRIVATE HEALTHCARE SYSTEM | OTHER | 84413 | 01 | CHILDRENS MEDICAL SECURIT | OTHER | MO4221 | 01 | MEDICARE B | OTHER | M04221 | 01 | BLUE SHIELD INDEMNITY | OTHER | 28726 | 01 | FALLON COMMUNITY HEALTH P | OTHER | M04221 | 01 | BLUE SHIELD HMO BLUE | OTHER |