Provider Demographics
NPI:1972593648
Name:BOND, THOMAS CANNON (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:CANNON
Last Name:BOND
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 1:578 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-3900
Mailing Address - Country:US
Mailing Address - Phone:781-397-6789
Mailing Address - Fax:781-397-2597
Practice Address - Street 1:578 MAIN ST
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-3900
Practice Address - Country:US
Practice Address - Phone:781-397-6789
Practice Address - Fax:781-397-2597
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-25
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0372332084P0800X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA037233OtherMEDICAL LICENSE
MA3092941Medicaid
B72636Medicare UPIN
MA037233OtherMEDICAL LICENSE