Individual
DR. STACIA L. THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AUD
Contact information
Practice address
1250 FOREST AVE, STE 301, PORTLAND, ME 04103-1889
(207) 797-5753
Mailing address
190 RIVERSIDE ST, SUITE 6B, PORTLAND, ME 04103-1073
(207) 661-2000
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
AP2351
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003479200
—
FL
01
—
E400159752
MEDICARE PTAN
ME
01
—
E400160375
MEDICARE PTAN
ME
Enumeration date
03/11/2011
Last updated
04/27/2017
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