Provider Demographics
NPI:1255329652
Name:THOMAS, BEATRIX SYLVIE (MD)
Entity Type:Individual
Prefix:
First Name:BEATRIX
Middle Name:SYLVIE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 WOODLAND RD
Mailing Address - Street 2:SUITE 119
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-1702
Mailing Address - Country:US
Mailing Address - Phone:781-665-7557
Mailing Address - Fax:781-662-2957
Practice Address - Street 1:3 WOODLAND RD
Practice Address - Street 2:SUITE 119
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180-1702
Practice Address - Country:US
Practice Address - Phone:781-665-7557
Practice Address - Fax:781-662-2957
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA44853207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2087936Medicaid
MA2087936Medicaid
MAC04960Medicare PIN