Provider Demographics
NPI:1689731598
Name:THOMA, LAUREN PARK (MD)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:PARK
Last Name:THOMA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:RAE
Other - Last Name:PARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:520 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6419
Mailing Address - Country:US
Mailing Address - Phone:212-447-2325
Mailing Address - Fax:
Practice Address - Street 1:520 1ST AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6419
Practice Address - Country:US
Practice Address - Phone:212-447-2325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY256362-1207ZF0201X
PAMD438970207ZF0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic Pathology