Healthcare Provider Details

I. General information

NPI: 1356327886
Provider Name (Legal Business Name): AUDRIA A THOMAS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2005
Last Update Date: 05/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9149 ESTATE THOMAS PARAGON MEDICAL BLDG. STE 202
ST THOMAS VI
00802-2687
US

IV. Provider business mailing address

PO BOX 595
ST THOMAS VI
00804-0595
US

V. Phone/Fax

Practice location:
  • Phone: 340-776-5507
  • Fax: 340-776-7935
Mailing address:
  • Phone: 340-776-5507
  • Fax: 340-776-7935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberVI 717
License Number StateVI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: