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General NPI Number Information
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NPI Number | 1407874167
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Entity Type | Individual
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Provider Name | CHARLES RICHARD THOMAS JR. MD
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Gender | Male
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 11/04/2021
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Provider Practice Location Address
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Address Line | 1 MEDICAL CENTER DR
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City | LEBANON
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State | NH
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Zip | 03756-0001
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Country | US
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Telephone | 603-650-6600
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Fax |
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Provider Business Mailing Address
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Address Line | 3181 SW SAM JACKSON PARK ROAD MAIL CODE KPV4
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City | PORTLAND
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State | OR
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Zip | 97239-3098
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Country | US
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Telephone | 503-494-8758
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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 | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | MD26549
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 042.0015551
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License Number State | VT
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Taxonomy #3
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | MD00028703
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License Number State | WA
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Taxonomy #4
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 22087
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License Number State | NH
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