Provider Demographics
NPI:1316141294
Name:THOMAS, KEVIN (DPM)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:THOMAS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 RIVERSIDE DR
Mailing Address - Street 2:SUITE A-101
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-4700
Mailing Address - Country:US
Mailing Address - Phone:410-749-0121
Mailing Address - Fax:410-749-6807
Practice Address - Street 1:560 RIVERSIDE DR
Practice Address - Street 2:SUITE A-101
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-4700
Practice Address - Country:US
Practice Address - Phone:410-749-0121
Practice Address - Fax:410-749-6807
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC005904213ES0103X
MD01513213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDPENDINGOtherCAREFIRST
MD243715YHZXOtherMEDICARE UNSPECIFIED
MDPENDINGOtherBLUE SHIELD DC
MDPENDINGMedicaid
MDPENDINGOtherAETNA
MDPENDINGOtherRR MEDICARE