Provider Demographics
NPI:1336133909
Name:THOMAS, AMBER L (PA C)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:L
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:MISS
Other - First Name:AMBER
Other - Middle Name:L
Other - Last Name:ESPENSHADE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA C
Mailing Address - Street 1:214 PEACH ORCHARD RD
Mailing Address - Street 2:
Mailing Address - City:MC CONNELLSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17233-8559
Mailing Address - Country:US
Mailing Address - Phone:717-485-6110
Mailing Address - Fax:
Practice Address - Street 1:214 PEACH ORCHARD RD
Practice Address - Street 2:
Practice Address - City:MC CONNELLSBURG
Practice Address - State:PA
Practice Address - Zip Code:17233-8559
Practice Address - Country:US
Practice Address - Phone:717-485-6110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA003268363AS0400X
363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1567509OtherGATEWAY MEDICARE ASSURED
PA1926521OtherHIGHMARK BLUE SHIELD
PA0994759OtherKEYSTONE
PA0994759OtherKEYSTONE
Q05968Medicare UPIN
PAP00945814Medicare PIN
PA216275Medicare PIN
PA216275Medicare PIN
PAP00945814Medicare PIN