Provider Demographics
NPI:1629047030
Name:SUITS, THOMAS C (MD PA)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:C
Last Name:SUITS
Suffix:
Gender:M
Credentials:MD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 E OSCEOLA ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994
Mailing Address - Country:US
Mailing Address - Phone:772-220-9871
Mailing Address - Fax:772-220-7390
Practice Address - Street 1:401 E OSCEOLA ST
Practice Address - Street 2:SUITE 200
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994
Practice Address - Country:US
Practice Address - Phone:772-220-9871
Practice Address - Fax:772-220-7390
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0057977174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL45102OtherBC BS
FL260939300Medicaid
FLCB6757Medicare PIN
FLE71125Medicare UPIN
FL260939300Medicaid
FL4175160001Medicare NSC