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Individual

GORDON M THOMAS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.O.

Contact information

Practice address
79 NORTH ST, GRANVILLE FAMILY HEALTH CENTER, GRANVILLE, NY 12832-1137
(518) 642-0612
(518) 642-0693
Mailing address
100 PARK STREET, GLENS FALLS HOSPITAL - CREDENTIALING, GLENS FALLS, NY 12801-0304
(518) 926-5924
(518) 926-6983

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
140385
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00467116
NY
01
P00312976
RR MEDICARE
NY
Enumeration date
05/12/2006
Last updated
06/08/2021
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