Provider Demographics
NPI:1821040601
Name:THOMAS, JOAN L (MD)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:L
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:2365 S CLINTON AVE
Mailing Address - Street 2:SUITE #100
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-2663
Mailing Address - Country:US
Mailing Address - Phone:585-442-5320
Mailing Address - Fax:585-442-5526
Practice Address - Street 1:101 CANAL LANDING BLVD
Practice Address - Street 2:SUITE #8
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-5109
Practice Address - Country:US
Practice Address - Phone:585-239-7300
Practice Address - Fax:585-227-7723
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2021-05-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY159039207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01194150Medicaid
NYRA0146/70008A GRPMedicare PIN
E47173Medicare UPIN
NY01194150Medicaid