Individual
DR. GEORGE EDWIN THIBAULT
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
55 FRUIT ST, CLN 380, BOSTON, MA 02114-2696
(617) 724-1479
Mailing address
PO BOX 9142, MASS GENERAL PHYSICIAN ORGANIZATION, CHARLESTOWN, MA 02129-9142
(617) 724-0287
(617) 726-2894
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
35130
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2043521
—
MA
01
—
729756
TUFTS HEALTH PLAN
MA
01
—
M09208
BCBS MA
MA
Enumeration date
12/05/2005
Last updated
07/08/2007
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