Provider Demographics
NPI:1881630143
Name:THOMAS, ISAAC (MD)
Entity type:Individual
Prefix:DR
First Name:ISAAC
Middle Name:
Last Name:THOMAS
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 1:830 THOMAS MORE PKWY
Mailing Address - Street 2:# 202
Mailing Address - City:EDGEWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:41017-5102
Mailing Address - Country:US
Mailing Address - Phone:859-341-6281
Mailing Address - Fax:859-341-4661
Practice Address - Street 1:830 THOMAS MORE PKWY
Practice Address - Street 2:#202
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017-5102
Practice Address - Country:US
Practice Address - Phone:859-341-6281
Practice Address - Fax:859-341-4661
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-078078207RN0300X
KY34803207RN0300X
IN01049480A207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200454710Medicaid
OH2187664Medicaid
KY64015413Medicaid
IN200454710Medicaid
KY64015413Medicaid
OH4021851Medicare PIN