Healthcare Provider Details

I. General information

NPI: 1215930698
Provider Name (Legal Business Name): MARI K THOMAS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 12/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 RIVERHURST RD APT 203
BILLERICA MA
01821-3479
US

IV. Provider business mailing address

4 RIVERHURST RD APT 203
BILLERICA MA
01821-3479
US

V. Phone/Fax

Practice location:
  • Phone: 850-832-6470
  • Fax:
Mailing address:
  • Phone: 850-832-6470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS8386
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: