Provider Demographics
NPI:1114053717
Name:THOMAS, SEAN PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:PATRICK
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 1:1030 PRESIDENT AVE
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-5923
Mailing Address - Country:US
Mailing Address - Phone:508-676-3411
Mailing Address - Fax:508-673-0768
Practice Address - Street 1:1030 PRESIDENT AVE
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-5923
Practice Address - Country:US
Practice Address - Phone:508-676-3411
Practice Address - Fax:508-673-0768
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT183428207W00000X
MA231609207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2136902Medicaid
MA2136902Medicaid
MA000170101Medicare UPIN