Basic Information
| Provider Information | |||||||||
| NPI: | 1982692794 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VERDONE | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 417297 | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022417297 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8666233869 | ||||||||
| FaxNumber: | 3027092402 | ||||||||
| Practice Location | |||||||||
| Address1: | 111 GOOSE LN | ||||||||
| Address2: | |||||||||
| City: | GUILFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064375101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2034537100 | ||||||||
| FaxNumber: | 2034537810 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2005 | ||||||||
| LastUpdateDate: | 06/19/2015 | ||||||||
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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 | 174400000X | 031489 | CT | N | Other Service Providers | Specialist | 207L00000X | 031489 | CT | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 001314898 | 05 | CT | MEDICAID |