Provider Demographics
NPI:1033591839
Name:THOMAS, AMBER (PA)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PA
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3266 N MERIDIAN STREET
Mailing Address - Street 2:SUITE 101
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46208-5859
Mailing Address - Country:US
Mailing Address - Phone:317-925-0653
Mailing Address - Fax:317-925-0774
Practice Address - Street 1:3266 N MERIDIAN STREET
Practice Address - Street 2:SUITE 101
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46208-5859
Practice Address - Country:US
Practice Address - Phone:317-925-0653
Practice Address - Fax:317-925-0774
Is Sole Proprietor?:No
Enumeration Date:2015-06-29
Last Update Date:2021-11-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN10001835A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
INM38018010Medicare PIN