Provider Demographics
NPI:1750742342
Name:THOMAS, THERESA (MMS, PA-C)
Entity type:Individual
Prefix:MISS
First Name:THERESA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MMS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:278 EAGLEVIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-1157
Mailing Address - Country:US
Mailing Address - Phone:610-561-6400
Mailing Address - Fax:
Practice Address - Street 1:8919 NEW FALLS RD STE 17
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:PA
Practice Address - Zip Code:19054-1713
Practice Address - Country:US
Practice Address - Phone:267-580-4200
Practice Address - Fax:267-580-4201
Is Sole Proprietor?:No
Enumeration Date:2016-03-10
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA058136363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant