Provider Demographics
NPI:1033104708
Name:THOMAS, DEBORAH (PA)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 DAVOL SQ STE 400
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4760
Mailing Address - Country:US
Mailing Address - Phone:401-421-4000
Mailing Address - Fax:
Practice Address - Street 1:41 SANDERSON RD STE 201
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:RI
Practice Address - Zip Code:02917-2603
Practice Address - Country:US
Practice Address - Phone:401-949-0300
Practice Address - Fax:401-349-3387
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPA00246363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1033104708Medicaid
RI050483739OtherGREAT WEST HEALTH CARE
RI9004050Medicaid
RI30678OtherBCBS OF RI
RI709004048OtherMEDICARE GROUP
RI409543OtherBLUE CHIP
RI050483739OtherTIN #
RI709004048OtherMEDICARE GROUP
RI409543OtherBLUE CHIP