Healthcare Provider Details

I. General information

NPI: 1245271568
Provider Name (Legal Business Name): JOSEPH MARTIN THOMAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 09/13/2022
Certification Date: 05/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5442 PEACH ST
ERIE PA
16509-2602
US

IV. Provider business mailing address

5442 PEACH ST
ERIE PA
16509-2602
US

V. Phone/Fax

Practice location:
  • Phone: 814-833-7246
  • Fax: 814-833-1147
Mailing address:
  • Phone: 814-833-7246
  • Fax: 814-833-1147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberMD045797L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberMD045767L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: