Provider Demographics
NPI:1093700221
Name:FREUND, THOMAS (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:FREUND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 SYCAMORE ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-7207
Mailing Address - Country:US
Mailing Address - Phone:860-633-0500
Mailing Address - Fax:860-633-5250
Practice Address - Street 1:27 SYCAMORE ST
Practice Address - Street 2:SUITE 400
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-7207
Practice Address - Country:US
Practice Address - Phone:860-633-0500
Practice Address - Fax:860-633-5250
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-14
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT026417207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001264175Medicaid
CT001264175Medicaid
A92934Medicare UPIN