Provider Demographics
NPI:1285196238
Name:THOMAS, ERNEST JR
Entity Type:Individual
Prefix:MR
First Name:ERNEST
Middle Name:
Last Name:THOMAS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E GODFREY AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19120-1646
Mailing Address - Country:US
Mailing Address - Phone:267-671-7884
Mailing Address - Fax:
Practice Address - Street 1:300 E GODFREY AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19120-1646
Practice Address - Country:US
Practice Address - Phone:267-671-7884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-01
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000000000OtherI DONT HAVE ANOTHER NUMBER