Provider Demographics
NPI:1255334405
Name:THOMAS, DAVID W (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:W
Last Name:THOMAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:301-6 GREAT TEAYS BLVD
Mailing Address - Street 2:
Mailing Address - City:SCOTT DEPOT
Mailing Address - State:WV
Mailing Address - Zip Code:25560
Mailing Address - Country:US
Mailing Address - Phone:304-757-6999
Mailing Address - Fax:304-757-3252
Practice Address - Street 1:830 PENNSYLVANIA AVE
Practice Address - Street 2:STE 402
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25302-3390
Practice Address - Country:US
Practice Address - Phone:304-343-5736
Practice Address - Fax:304-343-5271
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV12093207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001722083OtherMS BCBS
WV4242420OtherAETNA
WV0094534000Medicaid
WV2030696Medicare PIN
WV2030697Medicare PIN
WV2030693Medicare PIN
WV0094534000Medicaid
WV2030694Medicare PIN
A72113Medicare UPIN
WV0512595Medicare PIN
WV4242420OtherAETNA
WV2030692Medicare PIN
WV2030695Medicare PIN