Provider Demographics
NPI:1114275393
Name:THOMAS, GRACE (MD)
Entity Type:Individual
Prefix:DR
First Name:GRACE
Middle Name:
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 1:1 PEARL ST STE 2000
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-2870
Mailing Address - Country:US
Mailing Address - Phone:508-897-6390
Mailing Address - Fax:508-897-6391
Practice Address - Street 1:1 PEARL ST STE 2000
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-2870
Practice Address - Country:US
Practice Address - Phone:508-897-6390
Practice Address - Fax:508-897-6391
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-21
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA278101207R00000X, 207RE0101X
MA253549208800000X
282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208800000XAllopathic & Osteopathic PhysiciansUrology
No282N00000XHospitalsGeneral Acute Care Hospital