Individual
MATTHEW BLAKE THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
15 4TH ST, MALONE, NY 12953-1340
(518) 481-8160
Mailing address
15 4TH ST, MALONE, NY 12953-1340
(518) 481-8160
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1987
—
NY
Enumeration date
08/30/2021
Last updated
08/30/2021
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