Healthcare Provider Details

I. General information

NPI: 1821175084
Provider Name (Legal Business Name): CHERYL A THOMAS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHERYL A HACKNEY

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 04/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8118 GOOD LUCK ROAD
LANHAM MD
20706-3596
US

IV. Provider business mailing address

8909 OLD BRANCH AVENUE
CLINTON MD
20735
US

V. Phone/Fax

Practice location:
  • Phone: 301-552-8130
  • Fax: 301-552-8135
Mailing address:
  • Phone: 301-868-7780
  • Fax: 301-868-9098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberC0002193
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: