Provider Demographics
NPI:1700878485
Name:THOMAS, AGNES (MD)
Entity Type:Individual
Prefix:DR
First Name:AGNES
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 CLAGUE RD STE 2480
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-1585
Mailing Address - Country:US
Mailing Address - Phone:440-250-5370
Mailing Address - Fax:440-250-2018
Practice Address - Street 1:960 CLAGUE RD STE 2480
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-1585
Practice Address - Country:US
Practice Address - Phone:440-250-5370
Practice Address - Fax:440-250-2018
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35064691207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0947542Medicaid
TH0753095Medicare ID - Type Unspecified
OH0947542Medicaid