Provider Demographics
NPI:1083695084
Name:THOMAS, KENNETH D (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:D
Last Name:THOMAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 TARRYTOWN RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103-2713
Mailing Address - Country:US
Mailing Address - Phone:603-622-7548
Mailing Address - Fax:603-622-4369
Practice Address - Street 1:182 TARRYTOWN RD
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-2713
Practice Address - Country:US
Practice Address - Phone:603-622-7548
Practice Address - Fax:603-622-4369
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH5754207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHE52436OtherANTHEM REFERRING UPIN
NH2499121OtherAETNA PIN
NH005754OtherTUFTS PIN
NH0441895OtherUHC PIN
NH2062OtherCIGNA PIN
NH40000193Medicaid
NHE52436OtherHPHC PIN
NHP602096OtherOXFORD PIN
NHP602096OtherOXFORD PIN
NH40000193Medicaid