Provider Demographics
NPI:1639243348
Name:HOWARD, THOMAS R (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:R
Last Name:HOWARD
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 1:567 SALEM QUINTON RD
Mailing Address - Street 2:STE C
Mailing Address - City:SALEM
Mailing Address - State:NJ
Mailing Address - Zip Code:08079-1255
Mailing Address - Country:US
Mailing Address - Phone:856-678-6411
Mailing Address - Fax:
Practice Address - Street 1:567 SALEM QUINTON RD
Practice Address - Street 2:STE C
Practice Address - City:SALEM
Practice Address - State:NJ
Practice Address - Zip Code:08079-1255
Practice Address - Country:US
Practice Address - Phone:856-678-6411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04466900208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
0151505000OtherAMERIHEALTH, HMO, KEYSTONE, IBC
22363OtherUNIVERSITY HEALTH
3K7742OtherHEALTHNET
5790213OtherCIGNA
SLP007OtherOXFORD HEALTH PLAN
115522OtherAETNA
SA0000006 01OtherAMERICHOICE
124518OtherAMERIHEALTH PPO
080108957OtherRAIL ROAD MEDICARE
1075190OtherHORIZON NJ HEALTH
2041530OtherUNITED HELATH CARE
NJ3823202Medicaid
115522OtherAETNA
E54336Medicare UPIN