Provider Demographics
NPI:1124071840
Name:THOMAS, MONTRAE CALHOUN (MD)
Entity type:Individual
Prefix:DR
First Name:MONTRAE
Middle Name:CALHOUN
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:M
Other - Middle Name:CALHOUN
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:485 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07050
Mailing Address - Country:US
Mailing Address - Phone:973-672-2770
Mailing Address - Fax:973-672-7009
Practice Address - Street 1:485 PARK AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07050
Practice Address - Country:US
Practice Address - Phone:973-672-2770
Practice Address - Fax:973-672-7009
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA35250208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3608409Medicaid
NJ3608409Medicaid