Provider Demographics
NPI:1558668780
Name:THOMAS, ADAM JOSEPH (PA-C)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:JOSEPH
Last Name:THOMAS
Suffix:
Gender:M
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 1:1 ELIZABETH PL BLDG G
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45417-3445
Mailing Address - Country:US
Mailing Address - Phone:937-280-4970
Mailing Address - Fax:937-630-4578
Practice Address - Street 1:1 ELIZABETH PL BLDG G
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417-3445
Practice Address - Country:US
Practice Address - Phone:937-280-4970
Practice Address - Fax:937-630-4578
Is Sole Proprietor?:No
Enumeration Date:2011-02-24
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-02782363AM0700X
IN10002678A363AM0700X
OH50.005899RX363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical