Provider Demographics
NPI:1215370986
Name:KEVIN THOMAS DPM PC
Entity Type:Organization
Organization Name:KEVIN THOMAS DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:470-749-0121
Mailing Address - Street 1:560 RIVERSIDE DR
Mailing Address - Street 2:SUITE A-101
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-4700
Mailing Address - Country:US
Mailing Address - Phone:410-749-0121
Mailing Address - Fax:410-749-6807
Practice Address - Street 1:200 2ND AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-5722
Practice Address - Country:US
Practice Address - Phone:570-288-9315
Practice Address - Fax:570-288-8081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-12
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC005904213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty