Provider Demographics
NPI:1457367427
Name:THOMAS, HEATHER LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:LYNN
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:744 JAMESTOWN CT
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-4415
Mailing Address - Country:US
Mailing Address - Phone:330-650-9975
Mailing Address - Fax:
Practice Address - Street 1:1365 KELSO RD
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240
Practice Address - Country:US
Practice Address - Phone:330-676-0488
Practice Address - Fax:330-676-0720
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35075171207Q00000X
MI4301087628207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2202557Medicaid
OH2202557Medicaid