Provider Demographics
NPI:1356327886
Name:THOMAS, AUDRIA A (MD)
Entity Type:Individual
Prefix:DR
First Name:AUDRIA
Middle Name:A
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 595
Mailing Address - Street 2:
Mailing Address - City:ST THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00804-0595
Mailing Address - Country:US
Mailing Address - Phone:340-776-5507
Mailing Address - Fax:340-776-7935
Practice Address - Street 1:9149 ESTATE THOMAS
Practice Address - Street 2:PARAGON MEDICAL BLDG. STE 202
Practice Address - City:ST THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802-2687
Practice Address - Country:US
Practice Address - Phone:340-776-5507
Practice Address - Fax:340-776-7935
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-16
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VIVI 717174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VIG40792Medicare UPIN