MEDICARE: MISS THERESA THOMAS MMS, PA-C

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	MA058136	PA

General Provider Information

NPI Number	:	1750742342
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS THERESA THOMAS MMS, PA-C

Provider Business Mailing Address
First Line	:	278 EAGLEVIEW BLVD
Second Line	:
City	:	EXTON
State	:	PA
Zip	:	19341-1157
Country	:	US
Telephone Number	:	610-561-6400
Fax Number	:

Provider Business Practice Location Address
First Line	:	8919 NEW FALLS RD STE 17
Second Line	:
City	:	LEVITTOWN
State	:	PA
Zip	:	19054-1713
Country	:	US
Telephone Number	:	267-580-4200
Fax Number	:	267-580-4201

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

Provider Enumeration Date	:	03/10/2016
Last Update Date	:	03/17/2018

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