Healthcare Provider Details

I. General information

NPI: 1649290289
Provider Name (Legal Business Name): ERIC JOSEPH THOMAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 S MAIN ST
MIDDLETOWN CT
06457-3656
US

IV. Provider business mailing address

11 S MAIN ST
MIDDLETOWN CT
06457-3656
US

V. Phone/Fax

Practice location:
  • Phone: 860-347-4555
  • Fax:
Mailing address:
  • Phone: 860-347-4555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number16529
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: