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General NPI Number Information
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NPI Number | 1063755262
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Entity Type | Organization
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Legal Business Name | KENNETH A. THOMAS MD LLC
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Dates
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Enumeration Date | 04/05/2013
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Last Update Date | 04/05/2013
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Provider Practice Location Address
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Address Line | 305 BOSTON AVE SUITE 205
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City | STRATFORD
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State | CT
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Zip | 06614-5246
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Country | US
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Telephone | 203-377-7670
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Fax | 203-377-6497
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Provider Business Mailing Address
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Address Line | 305 BOSTON AVE SUITE 205
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City | STRATFORD
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State | CT
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Zip | 06614-5246
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Country | US
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Telephone | 203-377-7670
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Fax | 203-377-6497
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Authorized Official
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Title or Position | OWNER
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Name | KENNETH AUSTIN THOMAS
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Credential | M.D.
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Telephone | 203-377-7670
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 25956
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License Number State | CT
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