Provider Demographics
NPI:1659308526
Name:THOMAS, VERONICA MITCHELL (MD)
Entity Type:Individual
Prefix:DR
First Name:VERONICA
Middle Name:MITCHELL
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 1:719 E AIRPORT AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-6558
Mailing Address - Country:US
Mailing Address - Phone:225-810-4785
Mailing Address - Fax:225-810-4788
Practice Address - Street 1:719 E AIRPORT AVE
Practice Address - Street 2:SUITE B
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-6558
Practice Address - Country:US
Practice Address - Phone:225-810-4785
Practice Address - Fax:225-810-4788
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA018148208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1378496OtherKID MED #
LA1200386OtherUNITED HEALTH PROVIDER #
LA1378496Medicaid
LA00241OtherCIGNA PROVIDER #
LA5143466OtherAETNA PROVIDER #
LA1200386OtherUNITED HEALTH PROVIDER #
LA1378496Medicaid