Provider Demographics
NPI:1023124260
Name:THOMAS, KENNETH AUSTIN (MD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:AUSTIN
Last Name:THOMAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 BOSTON AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-5246
Mailing Address - Country:US
Mailing Address - Phone:203-377-7670
Mailing Address - Fax:
Practice Address - Street 1:305 BOSTON AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-5246
Practice Address - Country:US
Practice Address - Phone:203-377-7670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT25956207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1259563Medicaid
CTC59899Medicare UPIN