Provider Demographics
NPI:1124631577
Name:THOMAS, DORIAN D'MERE CLINTON
Entity type:Individual
Prefix:
First Name:DORIAN
Middle Name:D'MERE CLINTON
Last Name:THOMAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 DELLSLOW LN
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-5971
Mailing Address - Country:US
Mailing Address - Phone:172-496-3187
Mailing Address - Fax:
Practice Address - Street 1:36 DELLSLOW LN
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-5971
Practice Address - Country:US
Practice Address - Phone:724-963-1874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVF906970374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide