Provider Demographics
NPI:1306877667
Name:THOMAS, MARK DREW (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:DREW
Last Name:THOMAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1448 10TH AVE STE 304
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-3579
Mailing Address - Country:US
Mailing Address - Phone:304-691-6381
Mailing Address - Fax:304-691-8591
Practice Address - Street 1:1115 20TH STREET
Practice Address - Street 2:SUITE 101
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25703-2071
Practice Address - Country:US
Practice Address - Phone:304-399-4121
Practice Address - Fax:304-399-4126
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3848208800000X
OH35132150208800000X
WV34647208800000X
MO2025006931208800000X
NM96-387208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM340012399OtherRAILROAD MEDICARE
TXB150200Medicare UPIN
NM340012399OtherRAILROAD MEDICARE