Basic Information
| Provider Information | |||||||||
| NPI: | 1821040601 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THOMAS | ||||||||
| FirstName: | JOAN | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2365 S CLINTON AVE | ||||||||
| Address2: | SUITE #100 | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146182663 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5854425320 | ||||||||
| FaxNumber: | 5854425526 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 CANAL LANDING BLVD | ||||||||
| Address2: | SUITE #8 | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146265109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5852397300 | ||||||||
| FaxNumber: | 5852277723 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2006 | ||||||||
| LastUpdateDate: | 05/25/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 159039 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0000X | 159039 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 01194150 | 05 | NY | MEDICAID |