Provider Demographics
NPI:1194792432
Name:THOMAS, ELIZABETH D (MD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:D
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2450 W HUNTING PARK AVE
Mailing Address - Street 2:FL 3
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19129-1302
Mailing Address - Country:US
Mailing Address - Phone:215-493-1750
Mailing Address - Fax:215-493-1470
Practice Address - Street 1:385 OXFORD VALLEY RD
Practice Address - Street 2:SUITE 311
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-7700
Practice Address - Country:US
Practice Address - Phone:215-493-1750
Practice Address - Fax:215-493-1470
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2023-07-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA08189300208000000X
PAMD059428L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016101850009Medicaid
PA0016101850009Medicaid
G33091Medicare UPIN