Provider Demographics
NPI:1154144301
Name:THOMAS, JEROME CLARENCE
Entity type:Individual
Prefix:
First Name:JEROME
Middle Name:CLARENCE
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 1:1030 SPA RD APT C
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21403-1168
Mailing Address - Country:US
Mailing Address - Phone:410-330-5992
Mailing Address - Fax:
Practice Address - Street 1:1834 GEORGE AVE
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-4103
Practice Address - Country:US
Practice Address - Phone:443-441-0631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist