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NPI Code Detail

MEDICARE: SUSANNA THOMAS M.D.

MEDICARE: SUSANNA THOMAS M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician028170CT

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
5080121849OTHERCTRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1010028170CT01OTHERCTANTHEM BLUE SHIELD
2028170OTHERCTCONNECTICARE
32143945OTHERCTAETNA
40R0177OTHERCTHEALTHNET

General Provider Information

NPI Number : 1093726192
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSANNA THOMAS M.D.
Provider Business Mailing Address
First Line : 1250 BOSTON POST RD
Second Line :
City : OLD SAYBROOK
State : CT
Zip : 06475-4405
Country : US
Telephone Number : 860-388-9250
Fax Number : 860-388-9687
Provider Business Practice Location Address
First Line : 1250 BOSTON POST RD
Second Line :
City : OLD SAYBROOK
State : CT
Zip : 06475-4405
Country : US
Telephone Number : 860-388-9250
Fax Number : 860-388-9687
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2006
Last Update Date : 12/15/2009

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Directions to “ SUSANNA THOMAS M.D.” Practice Location

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