Provider Demographics
NPI:1063401792
Name:THOMAS, FERN J (MD)
Entity type:Individual
Prefix:DR
First Name:FERN
Middle Name:J
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:531 SOUTHSIDE DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ONEONTA
Mailing Address - State:NY
Mailing Address - Zip Code:13820-3211
Mailing Address - Country:US
Mailing Address - Phone:607-436-9030
Mailing Address - Fax:607-436-9031
Practice Address - Street 1:531 SOUTHSIDE DR
Practice Address - Street 2:SUITE 2
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820-3211
Practice Address - Country:US
Practice Address - Phone:607-436-9030
Practice Address - Fax:607-436-9031
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1996602084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
7336432OtherGHI
NY02265992Medicaid
393599OtherMVP
488858OtherVALUE OPTIONS
10067574OtherCDPHP
393599OtherMVP
H53830Medicare UPIN