Provider Demographics
NPI:1144563685
Name:THOMAS, NATALIE ANNE
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:ANNE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25651 DETROIT RD STE 304
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-2415
Mailing Address - Country:US
Mailing Address - Phone:440-808-8620
Mailing Address - Fax:440-899-4372
Practice Address - Street 1:25651 DETROIT RD
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-2415
Practice Address - Country:US
Practice Address - Phone:440-808-8620
Practice Address - Fax:440-899-4372
Is Sole Proprietor?:No
Enumeration Date:2013-04-03
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH34.012327207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program