1821040601 NPI number — JOAN L THOMAS MD

Table of content: JOAN L THOMAS MD (NPI 1821040601)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821040601 NPI number — JOAN L THOMAS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMAS
Provider First Name:
JOAN
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1821040601
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/25/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2365 S CLINTON AVE
Provider Second Line Business Mailing Address:
SUITE #100
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14618-2663
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-442-5320
Provider Business Mailing Address Fax Number:
585-442-5526

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 CANAL LANDING BLVD
Provider Second Line Business Practice Location Address:
SUITE #8
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14626-5109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-239-7300
Provider Business Practice Location Address Fax Number:
585-227-7723
Provider Enumeration Date:
05/17/2006

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: 207R00000X , with the licence number:  159039 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X , with the licence number: 159039 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 01194150 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com