Individual
THERESA NICOLE THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
18 W BLACKWELL ST, DOVER, NJ 07801-3841
(973) 328-3344
Mailing address
18 W BLACKWELL ST, DOVER, NJ 07801-3841
(973) 328-3344
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
25MA10292100
NJ
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
25MA10292100
LICENSE NUMBER
NJ
Enumeration date
04/08/2015
Last updated
07/26/2019
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