Provider Demographics
NPI:1528378072
Name:THOMAS, ERIC DAVID (MD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:DAVID
Last Name:THOMAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 MOUNTAIN SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59602-8433
Mailing Address - Country:US
Mailing Address - Phone:908-625-7887
Mailing Address - Fax:
Practice Address - Street 1:601 MOUNTAIN SPRINGS RD
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59602-8433
Practice Address - Country:US
Practice Address - Phone:908-625-7887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-18
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD476250207R00000X
KY55990207R00000X
NJ25MA08851700207R00000X
UT12346821-1205207R00000X
KS04-45947207R00000X
IDM-15839207R00000X
MT49958207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0273431Medicaid
NJ0273431Medicaid