Provider Demographics
NPI:1548359391
Name:THOMAS, KEVIN A (DO)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:A
Last Name:THOMAS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:675 N BROAD STREET EXT
Mailing Address - Street 2:SUITE 4
Mailing Address - City:GROVE CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16127-5805
Mailing Address - Country:US
Mailing Address - Phone:724-458-8754
Mailing Address - Fax:724-662-2782
Practice Address - Street 1:675 N BROAD STREET EXT
Practice Address - Street 2:SUITE 4
Practice Address - City:GROVE CITY
Practice Address - State:PA
Practice Address - Zip Code:16127-5805
Practice Address - Country:US
Practice Address - Phone:724-458-8754
Practice Address - Fax:724-662-2782
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS010254L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1866468Medicaid
PA1866468Medicaid
PA055573Medicare PIN