Provider Demographics
NPI:1740528181
Name:THOMAS E MATHIAS DO, PA
Entity type:Organization
Organization Name:THOMAS E MATHIAS DO, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:MATHIAS
Authorized Official - Suffix:
Authorized Official - Credentials:DO, PA
Authorized Official - Phone:727-541-5544
Mailing Address - Street 1:6502 PARK BLVD N
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33781-3142
Mailing Address - Country:US
Mailing Address - Phone:727-541-5544
Mailing Address - Fax:727-546-8142
Practice Address - Street 1:6502 PARK BLVD N
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-3142
Practice Address - Country:US
Practice Address - Phone:727-541-5544
Practice Address - Fax:727-546-8142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-18
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0006027207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL06501700Medicaid
FL82847Medicare UPIN