Provider Demographics
NPI:1497857072
Name:THOMAS, ROGELIO I (MD)
Entity type:Individual
Prefix:DR
First Name:ROGELIO
Middle Name:I
Last Name:THOMAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 100773
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-0773
Mailing Address - Country:US
Mailing Address - Phone:718-421-0472
Mailing Address - Fax:718-434-8522
Practice Address - Street 1:249 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-3436
Practice Address - Country:US
Practice Address - Phone:718-322-7888
Practice Address - Fax:718-322-1880
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY162949-1207R00000X, 2083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY16G551Medicare ID - Type Unspecified
NYF20548Medicare UPIN