Provider Demographics
NPI:1164451605
Name:THOMAS, STEPHEN M (DO)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:M
Last Name:THOMAS
Suffix:
Gender:M
Credentials:DO
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 8500-6335
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-0001
Mailing Address - Country:US
Mailing Address - Phone:215-638-4340
Mailing Address - Fax:215-633-9710
Practice Address - Street 1:5000 BENSALEM BLVD
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-4043
Practice Address - Country:US
Practice Address - Phone:215-638-4340
Practice Address - Fax:215-633-9710
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS010140L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0797606000OtherKEYSTONE IBC
PA30068291OtherKEYSTONE FIRST
PA113518OtherHIGHMARK BLUE SHIELD
PA1023419790001Medicaid
PA7278167OtherAETNA
H15222Medicare UPIN
PA113518OtherHIGHMARK BLUE SHIELD
PA164193GH2Medicare PIN