Provider Demographics
NPI:1699758334
Name:KWIATKOWSKI, THOMAS JOSEPH JR (MD PHD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JOSEPH
Last Name:KWIATKOWSKI
Suffix:JR
Gender:M
Credentials:MD PHD
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Mailing Address - Street 1:725 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-4109
Mailing Address - Country:US
Mailing Address - Phone:413-447-2752
Mailing Address - Fax:413-496-6836
Practice Address - Street 1:777 NORTH ST
Practice Address - Street 2:NEUROLOGY
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-4147
Practice Address - Country:US
Practice Address - Phone:413-395-7694
Practice Address - Fax:413-496-6842
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD601147612084N0400X
NC2021-031322084N0400X
MA2088172084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0139777Medicaid
MAJ23214OtherBCBS MA
MA208817OtherTUFTS HEALTH PLAN
MA208817OtherTUFTS HEALTH PLAN
MAA33070Medicare ID - Type Unspecified