Healthcare Provider Details

I. General information

NPI: 1033104708
Provider Name (Legal Business Name): DEBORAH THOMAS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 04/09/2024
Certification Date: 04/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 SANDERSON RD STE 201
SMITHFIELD RI
02917-2603
US

IV. Provider business mailing address

10 DAVOL SQ STE 400
PROVIDENCE RI
02903-4760
US

V. Phone/Fax

Practice location:
  • Phone: 401-949-0300
  • Fax: 401-349-3387
Mailing address:
  • Phone: 401-421-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA00246
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: