Provider Demographics
NPI:1891723425
Name:THOMAS, ANN HOLLAND (PA)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:HOLLAND
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 36488
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28236-6488
Mailing Address - Country:US
Mailing Address - Phone:704-248-3400
Mailing Address - Fax:704-337-8387
Practice Address - Street 1:201 QUEENS RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-3217
Practice Address - Country:US
Practice Address - Phone:704-372-5180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102797363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCB1828OtherMEDCOST INDIVIDUAL PROV#
NC970022604OtherRAILROAD MEDICARE PROV #
NC970022604OtherRAILROAD MEDICARE PROV #
NC2752310AMedicare ID - Type Unspecified