1760423826 NPI number — DR. TRICIA LENNOX-THOMAS M.D.

Table of content: DR. TRICIA LENNOX-THOMAS M.D. (NPI 1760423826)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760423826 NPI number — DR. TRICIA LENNOX-THOMAS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LENNOX-THOMAS
Provider First Name:
TRICIA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760423826
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/30/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
225 SUNSET RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILLINGBORO
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08046-1109
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-877-2800
Provider Business Mailing Address Fax Number:
609-877-1813

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
225 SUNSET RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILLINGBORO
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08046-1109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-877-2800
Provider Business Practice Location Address Fax Number:
609-877-1813
Provider Enumeration Date:
06/09/2006

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: 207W00000X , with the licence number:  MD422546 , 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)

  • Identifier: 30028312 . This is a "KEYSTONE MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2761143 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0099015 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1725581 . This is a "BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: AETNA HMO . This is a "1233534" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 101475145 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1014751450001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2393936000 . This is a "KEYSTONE EAST" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 7079595 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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