Healthcare Provider Details

I. General information

NPI: 1154393957
Provider Name (Legal Business Name): DR. P. SEBASTIAN THOMAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 09/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 E ADAMS ST
SYRACUSE NY
13210-2306
US

IV. Provider business mailing address

163 INTREPID LN
SYRACUSE NY
13205-2548
US

V. Phone/Fax

Practice location:
  • Phone: 315-464-4720
  • Fax:
Mailing address:
  • Phone: 315-469-1130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number136963
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: