Basic Information
| Provider Information | |||||||||
| NPI: | 1205895422 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THOMAS | ||||||||
| FirstName: | JOELLEN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 655 | ||||||||
| Address2: | |||||||||
| City: | EXETER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038330655 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6037735200 | ||||||||
| FaxNumber: | 6037735233 | ||||||||
| Practice Location | |||||||||
| Address1: | 9 BUZELL AVE | ||||||||
| Address2: | |||||||||
| City: | EXETER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038332595 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6037735200 | ||||||||
| FaxNumber: | 6037735233 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/18/2006 | ||||||||
| LastUpdateDate: | 04/26/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 4283 | NH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 82013564 | 05 | NH | MEDICAID |