Provider Demographics
NPI:1144439274
Name:LUSA, THOMAS R (RNMS)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:R
Last Name:LUSA
Suffix:
Gender:M
Credentials:RNMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 BENMONT AVE
Mailing Address - Street 2:STE. 24
Mailing Address - City:BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05201-1873
Mailing Address - Country:US
Mailing Address - Phone:413-496-1831
Mailing Address - Fax:
Practice Address - Street 1:160 BENMONT AVE
Practice Address - Street 2:STE. 24
Practice Address - City:BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05201-1873
Practice Address - Country:US
Practice Address - Phone:413-496-1831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist