MEDICARE: BRENDA W. THOMAS P.A.

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
1	363A00000X	Physician Assistant	102700	NC

General Provider Information

NPI Number	:	1184748816
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENDA W. THOMAS P.A.

Provider Business Mailing Address
First Line	:	10900 WORLD TRADE BLVD STE 1
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27617-4202
Country	:	US
Telephone Number	:	919-237-1337
Fax Number	:	919-237-1625

Provider Business Practice Location Address
First Line	:	1964 S MAIN ST
Second Line	:
City	:	WAKE FOREST
State	:	NC
Zip	:	27587-9336
Country	:	US
Telephone Number	:	919-554-0177
Fax Number	:	919-554-9277

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	09/07/2021

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