Provider Demographics
NPI:1104081223
Name:THOMAS, JONELLE MARIE (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:JONELLE
Middle Name:MARIE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:JONELLE
Other - Middle Name:MARIE
Other - Last Name:PETSCAVAGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 858
Mailing Address - Street 2:MC A410
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-0858
Mailing Address - Country:US
Mailing Address - Phone:800-243-1455
Mailing Address - Fax:
Practice Address - Street 1:500 UNIVERSITY DR
Practice Address - Street 2:PENN STATE HERSHEY MEDICAL CENTER
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-2360
Practice Address - Country:US
Practice Address - Phone:717-531-8044
Practice Address - Fax:717-531-5596
Is Sole Proprietor?:No
Enumeration Date:2008-07-29
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4399052085R0202X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1024721100001Medicaid