Provider Demographics
NPI:1659477560
Name:THOMAS, KEVIN W (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:W
Last Name:THOMAS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4567 CROSSROADS PARK DR
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-3589
Mailing Address - Country:US
Mailing Address - Phone:315-295-2100
Mailing Address - Fax:315-295-2125
Practice Address - Street 1:5700 W GENESEE ST
Practice Address - Street 2:STE 124
Practice Address - City:CAMILLUS
Practice Address - State:NY
Practice Address - Zip Code:13031-3200
Practice Address - Country:US
Practice Address - Phone:315-472-8841
Practice Address - Fax:315-472-8859
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2014-08-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY1664452084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01037663Medicaid
D02306Medicare UPIN
NYRB1864Medicare PIN
NYP00374435Medicare PIN