Provider Demographics
NPI:1750456513
Name:CHRISTINE T THOMAS MD PA
Entity Type:Organization
Organization Name:CHRISTINE T THOMAS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:T
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:321-752-9722
Mailing Address - Street 1:2571 W EAU GALLIE BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-8954
Mailing Address - Country:US
Mailing Address - Phone:321-752-9722
Mailing Address - Fax:321-752-9710
Practice Address - Street 1:2571 W EAU GALLIE BLVD STE 1
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-8954
Practice Address - Country:US
Practice Address - Phone:321-752-9722
Practice Address - Fax:321-752-9710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME77228207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1639159262OtherNPI
FL263914900Medicaid
FL1639159262OtherNPI
FL263914900Medicaid