Provider Demographics
NPI:1194972471
Name:THOMAS, ZORINA MICHELLE (PA-C)
Entity type:Individual
Prefix:
First Name:ZORINA
Middle Name:MICHELLE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19785 CRYSTAL ROCK DRIVE
Mailing Address - Street 2:SUITE 209
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874
Mailing Address - Country:US
Mailing Address - Phone:301-515-2901
Mailing Address - Fax:301-515-2902
Practice Address - Street 1:19785 CRYSTAL ROCK DRIVE
Practice Address - Street 2:SUITE 209
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874
Practice Address - Country:US
Practice Address - Phone:301-515-2901
Practice Address - Fax:301-515-5950
Is Sole Proprietor?:No
Enumeration Date:2008-08-19
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085003167363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL085003167OtherILLINOIS
IL207989002Medicare PIN
IL085003167OtherILLINOIS
IL207710002Medicare PIN