Provider Demographics
NPI:1386736635
Name:BINDER, THOMAS B (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:B
Last Name:BINDER
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 1:21B ARTS CENTER COURT
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-3752
Mailing Address - Country:US
Mailing Address - Phone:860-673-9400
Mailing Address - Fax:860-678-9480
Practice Address - Street 1:21B ARTS CENTER COURT
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-3752
Practice Address - Country:US
Practice Address - Phone:860-673-9400
Practice Address - Fax:860-678-9480
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT039276208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
743102100OtherFEDERAL TAX ID#
CT001392761Medicaid