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General NPI Number Information
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NPI Number | 1013670629
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Entity Type | Individual
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Provider Name | CARL EDWARD THOMAS I
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Gender | Male
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Dates
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Enumeration Date | 10/20/2021
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Last Update Date | 10/20/2021
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Provider Practice Location Address
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Address Line | 77 APRIL LN
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City | PITTSFIELD
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State | MA
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Zip | 01201-4457
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Country | US
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Telephone | 413-204-1496
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Fax |
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Provider Business Mailing Address
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Address Line | 68 PEASE AVE
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City | DALTON
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State | MA
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Zip | 01226-1331
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Country | US
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Telephone | 413-347-1565
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | LN57219
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License Number State | MA
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