Provider Demographics
NPI:1174688998
Name:THOMAS, YOLANDE MARY (DO)
Entity Type:Individual
Prefix:DR
First Name:YOLANDE
Middle Name:MARY
Last Name:THOMAS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1259 EAST 55TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-3325
Mailing Address - Country:US
Mailing Address - Phone:929-210-9770
Mailing Address - Fax:929-210-9772
Practice Address - Street 1:5018 AVE D
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-5906
Practice Address - Country:US
Practice Address - Phone:929-210-9770
Practice Address - Fax:929-210-9772
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY216550207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02105246Medicaid
NYH39755Medicare UPIN
NY02105246Medicaid