Healthcare Provider Details

I. General information

NPI: 1114909017
Provider Name (Legal Business Name): LONICE M. THOMAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 ATWOOD ST
PROVIDENCE RI
02909-3410
US

IV. Provider business mailing address

375 ALLENS AVE
PROVIDENCE RI
02905-5010
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-0590
  • Fax: 401-396-2084
Mailing address:
  • Phone: 401-444-0400
  • Fax: 401-444-0468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD06679
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: