1194816082 NPI number — THOMAS A PEARSON MD, PHD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194816082 NPI number — THOMAS A PEARSON MD, PHD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

PEARSON

Provider First Name:

THOMAS

Provider Middle Name:

A

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD, PHD

Provider Gender Code:

M

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:

1194816082

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

02/25/2015

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 13833

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

PHILADELPHIA

Provider Business Mailing Address State Name:

PA

Provider Business Mailing Address Postal Code:

19101-3833

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

1600 SW ARCHER RD

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

GAINESVILLE

Provider Business Practice Location Address State Name:

FL

Provider Business Practice Location Address Postal Code:

32610-3001

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

352-733-1800

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

09/27/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207RC0000X , with the licence number:  175541 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207R00000X , with the licence number: 175541 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207R00000X , with the licence number: ME122156 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 01166509 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
• Identifier: P010175541 . This is a "BLUE CHOICE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 013846400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
• Identifier: 5058740 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 00046035501 . This is a "UNIVERA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 005249471 . This is a "BC/BS WESTERN NY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 0635 . This is a "BLUE SHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: MDC137 . This is a "PREFERRED CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 013846400 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".