Healthcare Provider Details

I. General information

NPI: 1255575726
Provider Name (Legal Business Name): ALISSA A. THOMAS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2009
Last Update Date: 07/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 COLCHESTER AVE. UVM MEDICAL CENTER - DEPT. OF NEUROLOGY
BURLINGTON VT
05401
US

IV. Provider business mailing address

111 COLCHESTER AVE. UVM MEDICAL CENTER - DEPT. OF NEUROLOGY
BURLINGTON VT
05401
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-4589
  • Fax: 802-847-2461
Mailing address:
  • Phone: 802-847-4589
  • Fax: 802-847-2461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number042.0013100
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: