Individual
THOMAS PROVOST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
10633
NH
207LP2900X
Pain Medicine (Anesthesiology) Physician
10633
NH
208VP0014X
Interventional Pain Medicine Physician
10633
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
050071165
RAILROAD MEDICARE
—
05
—
30220464
—
NH
Enumeration date
06/07/2006
Last updated
04/02/2020
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