Provider Demographics
NPI:1194816082
Name:PEARSON, THOMAS A (MD, PHD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:A
Last Name:PEARSON
Suffix:
Gender:M
Credentials:MD, PHD
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 13833
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19101-3833
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3001
Practice Address - Country:US
Practice Address - Phone:352-733-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY175541207RC0000X, 207R00000X
FLME122156207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01166509Medicaid
NYP010175541OtherBLUE CHOICE
FL013846400Medicaid
NY5058740OtherAETNA
NY00046035501OtherUNIVERA
NY005249471OtherBC/BS WESTERN NY
NY0635OtherBLUE SHIELD
NYMDC137OtherPREFERRED CARE
FLIB287ZMedicare PIN
NY005249471OtherBC/BS WESTERN NY
NY0635OtherBLUE SHIELD