Provider Demographics
NPI:1083666333
Name:THOMAS, CAROLE E (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROLE
Middle Name:E
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:301 LIPPINCOTT DR STE 410
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4197
Mailing Address - Country:US
Mailing Address - Phone:856-355-0340
Mailing Address - Fax:856-355-0330
Practice Address - Street 1:693 MAIN ST
Practice Address - Street 2:BUILDING D
Practice Address - City:LUMBERTON
Practice Address - State:NJ
Practice Address - Zip Code:08048-5043
Practice Address - Country:US
Practice Address - Phone:609-261-7600
Practice Address - Fax:609-265-8205
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA080576002084N0400X
PAMD047947L2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7265603Medicaid
PA740106Medicare ID - Type Unspecified
740106SK3Medicare PIN
F54076Medicare UPIN