Healthcare Provider Details

I. General information

NPI: 1598344954
Provider Name (Legal Business Name): KATHRYN ADDY THOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2021
Last Update Date: 09/27/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 WOODLAND ST
HARTFORD CT
06105-1207
US

IV. Provider business mailing address

8 GREENLEAF WOODS DR
PORTSMOUTH NH
03801-5454
US

V. Phone/Fax

Practice location:
  • Phone: 860-714-4212
  • Fax:
Mailing address:
  • Phone: 603-422-8208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34229
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number78066
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number334906
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1020156
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: