Provider Demographics
NPI:1639496243
Name:THOMAS, KELTON MANOR (MD)
Entity Type:Individual
Prefix:DR
First Name:KELTON
Middle Name:MANOR
Last Name:THOMAS
Suffix:
Gender:M
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:UNIT 6180 BOX 245
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09604-6180
Mailing Address - Country:US
Mailing Address - Phone:314-632-5250
Mailing Address - Fax:
Practice Address - Street 1:MONTEREALE 24, BUILDING 121
Practice Address - Street 2:
Practice Address - City:AVIANO
Practice Address - State:AE
Practice Address - Zip Code:33170
Practice Address - Country:IT
Practice Address - Phone:314-632-5250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-23
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012518122084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry