Provider Demographics
NPI:1821175084
Name:THOMAS, CHERYL A (PA)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:A
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:A
Other - Last Name:HACKNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8909 OLD BRANCH AVENUE
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735
Mailing Address - Country:US
Mailing Address - Phone:301-868-7780
Mailing Address - Fax:301-868-9098
Practice Address - Street 1:8118 GOOD LUCK ROAD
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3596
Practice Address - Country:US
Practice Address - Phone:301-552-8130
Practice Address - Fax:301-552-8135
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0002193363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
R23810Medicare UPIN
017680Medicare ID - Type Unspecified