Provider Demographics
NPI:1336597103
Name:THOMAS, BLESSAN (MD)
Entity Type:Individual
Prefix:
First Name:BLESSAN
Middle Name:
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 1:1125 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:BEAVER FALLS
Mailing Address - State:PA
Mailing Address - Zip Code:15010-4426
Mailing Address - Country:US
Mailing Address - Phone:724-773-8900
Mailing Address - Fax:724-770-7947
Practice Address - Street 1:800 MONTAUK HWY STE 18
Practice Address - Street 2:
Practice Address - City:SHIRLEY
Practice Address - State:NY
Practice Address - Zip Code:11967-2128
Practice Address - Country:US
Practice Address - Phone:631-772-4646
Practice Address - Fax:631-772-2495
Is Sole Proprietor?:No
Enumeration Date:2016-06-02
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT211715390200000X
NY301468207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program