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General NPI Number Information
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NPI Number | 1073589610
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Entity Type | Individual
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Provider Name | ALLAN C THOMAS CRNA
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Gender | Male
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Dates
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Enumeration Date | 02/24/2006
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Last Update Date | 08/15/2024
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Provider Practice Location Address
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Address Line | 1153 CENTRE ST
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City | JAMAICA PLAIN
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State | MA
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Zip | 02130-3446
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Country | US
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Telephone | 617-983-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 21 ALAMEDA RD
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City | WEST ROXBURY
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State | MA
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Zip | 02132-1517
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Country | US
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Telephone | 617-323-6495
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Fax | 617-323-6495
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 210969
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License Number State | MA
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