Healthcare Provider Details

I. General information

NPI: 1972575330
Provider Name (Legal Business Name): STEPHEN THOMAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 10/26/2020
Certification Date: 10/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAL HOSPITAL CAMP PENDLETON EMERGENCY DEPARTMENT
OCEANSIDE CA
92055-5191
US

IV. Provider business mailing address

2800 MAIN ST
BRIDGEPORT CT
06606-4201
US

V. Phone/Fax

Practice location:
  • Phone: 619-865-1724
  • Fax:
Mailing address:
  • Phone: 475-210-5604
  • Fax: 475-210-6368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA77076
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number239025
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number62040
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: