Provider Demographics
NPI:1417976531
Name:THOMAS, TERESA ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:ELIZABETH
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 1:101 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-5020
Mailing Address - Country:US
Mailing Address - Phone:732-886-9400
Mailing Address - Fax:732-905-7719
Practice Address - Street 1:101 PROSPECT ST STE 212
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5003
Practice Address - Country:US
Practice Address - Phone:732-886-9400
Practice Address - Fax:732-905-7719
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA05660400207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ687642Medicare ID - Type UnspecifiedMEDICARE
NJE98643Medicare UPIN