Healthcare Provider Details

I. General information

NPI: 1659519346
Provider Name (Legal Business Name): PATRICIA JANN THOMAS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2009
Last Update Date: 11/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

798 CENTERTON RD
ELMER NJ
08318-3945
US

IV. Provider business mailing address

798 CENTERTON RD
ELMER NJ
08318-3945
US

V. Phone/Fax

Practice location:
  • Phone: 856-358-6161
  • Fax:
Mailing address:
  • Phone: 856-358-6161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOT013278
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MB09125300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: