Provider Demographics
NPI:1720081953
Name:THOMAS, JOSEPH P
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:P
Last Name:THOMAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1445 HARRISON AVE NW
Mailing Address - Street 2:STE 200
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708
Mailing Address - Country:US
Mailing Address - Phone:330-453-8116
Mailing Address - Fax:330-453-8644
Practice Address - Street 1:1445 HARRISON AVE NW
Practice Address - Street 2:STE 200
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708
Practice Address - Country:US
Practice Address - Phone:330-453-8116
Practice Address - Fax:330-453-8644
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35023763207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH8740607Medicaid
OH8740607Medicaid
D31728Medicare UPIN