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General NPI Number Information
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NPI Number | 1437344090
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Entity Type | Organization
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Legal Business Name | SUSANNA THOMAS
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Dates
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Enumeration Date | 09/07/2007
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Last Update Date | 01/07/2008
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Provider Practice Location Address
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Address Line | 1250 BOSTON POST RD
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City | OLD SAYBROOK
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State | CT
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Zip | 06475-4405
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Country | US
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Telephone | 860-388-9250
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Fax | 860-388-9687
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Provider Business Mailing Address
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Address Line | 1250 BOSTON POST RD
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City | OLD SAYBROOK
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State | CT
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Zip | 06475-4405
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Country | US
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Telephone | 860-388-9250
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Fax | 860-388-9687
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | JANE ADAMS
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Credential |
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Telephone | 860-388-9250
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 028170
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License Number State | CT
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