Provider Demographics
NPI:1194762724
Name:SCAMMELL, THOMAS E (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:E
Last Name:SCAMMELL
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 1:79 MAYO RD
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02482-1037
Mailing Address - Country:US
Mailing Address - Phone:617-735-3260
Mailing Address - Fax:
Practice Address - Street 1:375 LONGWOOD AVE STE 3
Practice Address - Street 2:HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACO
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5395
Practice Address - Country:US
Practice Address - Phone:617-632-7441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA783782084N0400X, 2084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ30107OtherBLUE SHIELD
MA078378OtherTUFTS HEALTH PLAN
MA3114767Medicaid
MAF66310Medicare UPIN
MA3114767Medicaid