Provider Demographics
NPI:1326090648
Name:THOMAS, KOCHUMOL (MD)
Entity Type:Individual
Prefix:MISS
First Name:KOCHUMOL
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 1:22 ST PAUL DR STE 200
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-1033
Mailing Address - Country:US
Mailing Address - Phone:717-709-7922
Mailing Address - Fax:717-263-2055
Practice Address - Street 1:820 5TH AVE
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-4219
Practice Address - Country:US
Practice Address - Phone:717-709-7999
Practice Address - Fax:717-263-6922
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2017-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 435145207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine