Healthcare Provider Details

I. General information

NPI: 1255334405
Provider Name (Legal Business Name): DAVID W THOMAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 08/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 PENNSYLVANIA AVE STE 402
CHARLESTON WV
25302-3390
US

IV. Provider business mailing address

301-6 GREAT TEAYS BLVD
SCOTT DEPOT WV
25560
US

V. Phone/Fax

Practice location:
  • Phone: 304-343-5736
  • Fax: 304-343-5271
Mailing address:
  • Phone: 304-757-6999
  • Fax: 304-757-3252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number12093
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: