Provider Demographics
NPI:1134113640
Name:THOMAS, CHERRYL L (MD)
Entity Type:Individual
Prefix:DR
First Name:CHERRYL
Middle Name:L
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 58
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08823-0058
Mailing Address - Country:US
Mailing Address - Phone:732-658-1375
Mailing Address - Fax:732-658-1376
Practice Address - Street 1:18 CENTRE DR. SUITE 205
Practice Address - Street 2:
Practice Address - City:MONROE TWP
Practice Address - State:NJ
Practice Address - Zip Code:08831
Practice Address - Country:US
Practice Address - Phone:732-658-1375
Practice Address - Fax:732-658-1376
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05345200174400000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ19126OtherUNIVERSITY HEALTH PLANS
NJ5084649OtherAETNA#
NJ0404769000OtherAMERIHEALTH#
NJ210751OtherUNIFORMED SERVICES FHP#
NJ3610209Medicaid
NJ2069923OtherAETNA (HMO)(CAPITATED)#
NJ223586872OtherTAX ID#
NJOK9320OtherHEALTH NET#
NJP1078964OtherOXFORD#
NJ110230391OtherRR MDCR #
NJ2598310OtherGHI (PPO)#
NJ37N381OtherBC/BS NY(HMO/PPO/EPO/POS
NJ223586872OtherTAX ID#
NJ110230391OtherRR MDCR #