1487086310 NPI number — MRS. PRABHA THOMAS FNP-BC

Table of content: MRS. PRABHA THOMAS FNP-BC (NPI 1487086310)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487086310 NPI number — MRS. PRABHA THOMAS FNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMAS
Provider First Name:
PRABHA
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SAMUEL
Provider Other First Name:
PRABHA
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1487086310
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/14/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
41 UNIVERSITY DR STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18940-1873
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-710-7037
Provider Business Mailing Address Fax Number:
215-710-5181

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1205 LANGHORNE NEWTOWN RD STE 403
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LANGHORNE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19047
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-710-4460
Provider Business Practice Location Address Fax Number:
215-710-4465
Provider Enumeration Date:
08/02/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  SP012761 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)