Provider Demographics
NPI:1093796500
Name:THOMAS, CATHERINE M (MD)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:M
Last Name:THOMAS
Suffix:
Gender:F
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:PO BOX 1729
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39403-1729
Mailing Address - Country:US
Mailing Address - Phone:601-545-8700
Mailing Address - Fax:601-456-0249
Practice Address - Street 1:66 OLD AIRPORT RD
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-8382
Practice Address - Country:US
Practice Address - Phone:601-544-7500
Practice Address - Fax:601-544-7524
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS17738207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1741356OtherUNITED HEALTH CARE PROVIDER I D NUMBER
MS00126802Medicaid
MS11349864OtherCAQH ID NUMBER
MS7445541OtherAETNA
MS110001589Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
MS00126802Medicaid