Provider Demographics
NPI:1851478887
Name:THOMAS, BETHANY WILLS (ANP)
Entity Type:Individual
Prefix:MS
First Name:BETHANY
Middle Name:WILLS
Last Name:THOMAS
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:482 BEDFORD ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420-1402
Mailing Address - Country:US
Mailing Address - Phone:781-672-2250
Mailing Address - Fax:781-672-2259
Practice Address - Street 1:482 BEDFORD ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-1402
Practice Address - Country:US
Practice Address - Phone:781-672-2250
Practice Address - Fax:781-672-2259
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA179547261QA0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MATHNP1152Medicare UPIN