MEDICARE: ANN MARY THOMAS PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	25MP00306700	NJ

General Provider Information

NPI Number	:	1356789861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANN MARY THOMAS PA

Provider Business Mailing Address
First Line	:	130A W PLEASANT AVE
Second Line	:
City	:	MAYWOOD
State	:	NJ
Zip	:	07607-1357
Country	:	US
Telephone Number	:	201-820-4477
Fax Number	:

Provider Business Practice Location Address
First Line	:	130A W PLEASANT AVE
Second Line	:
City	:	MAYWOOD
State	:	NJ
Zip	:	07607-1357
Country	:	US
Telephone Number	:	201-820-4477
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2013
Last Update Date	:	10/11/2013

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Directions to “ ANN MARY THOMAS PA” Practice Location

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