Provider Demographics
NPI:1316359045
Name:THOMAS, PERSIS (MD)
Entity Type:Individual
Prefix:
First Name:PERSIS
Middle Name:
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 1:95 WOODLAND ST FL 1
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-1230
Mailing Address - Country:US
Mailing Address - Phone:860-714-7362
Mailing Address - Fax:860-714-8140
Practice Address - Street 1:1162 NEW BRITAIN AVE
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06110-2410
Practice Address - Country:US
Practice Address - Phone:860-236-3084
Practice Address - Fax:860-561-5961
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-29
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT56651208000000X
NJ25MA10824600208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics