MEDICARE: DELORES THOMAS

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	374U00000X	Home Health Aide	HHA11118	DC

General Provider Information

NPI Number	:	1568820793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DELORES THOMAS

Provider Business Mailing Address
First Line	:	1911 DANA DR
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20783-2120
Country	:	US
Telephone Number	:	301-693-7011
Fax Number	:

Provider Business Practice Location Address
First Line	:	1010 WISCONSIN AVE NW STE 300
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20007-3680
Country	:	US
Telephone Number	:	202-955-8355
Fax Number	:

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

Provider Enumeration Date	:	02/02/2016
Last Update Date	:	02/02/2016

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