Provider Demographics
NPI:1104841527
Name:THOMAS, STACI JONES (MD)
Entity Type:Individual
Prefix:
First Name:STACI
Middle Name:JONES
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 1127
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26507-1127
Mailing Address - Country:US
Mailing Address - Phone:304-598-4032
Mailing Address - Fax:304-598-4143
Practice Address - Street 1:608 CHEAT RD
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-4210
Practice Address - Country:US
Practice Address - Phone:304-594-1313
Practice Address - Fax:304-594-2408
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV20750208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1808409000Medicaid
MD404274300Medicaid
PA1012400040001Medicaid
WV7333391Medicare PIN