Provider Demographics
NPI:1942303151
Name:EADS, THOMAS J (MD)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:J
Last Name:EADS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 SOUTH PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143
Mailing Address - Country:US
Mailing Address - Phone:317-889-7546
Mailing Address - Fax:317-889-2482
Practice Address - Street 1:53 SOUTH PARK BLVD
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143
Practice Address - Country:US
Practice Address - Phone:317-889-7546
Practice Address - Fax:317-889-2482
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01047160207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
8065087002OtherCIGNA
IN7115094OtherAETNA
IN000000212068OtherANTHEM
H17291Medicare UPIN
IN000000212068OtherANTHEM