Basic Information
| Provider Information | |||||||||
| NPI: | 1831147180 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THOMAS | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | W. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 980 US HIGHWAY 9 | ||||||||
| Address2: | |||||||||
| City: | SOUTH AMBOY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088793320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7325539729 | ||||||||
| FaxNumber: | 7325539730 | ||||||||
| Practice Location | |||||||||
| Address1: | 2412-14 WEST PASSYUNK AVE | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19145 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154622100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | MD417576 | PA | X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0204X | MD417576 | PA | X | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology |
ID Information
| ID | Type | State | Issuer | Description | 1316606 | 01 | PA | HIGHMARK BLUESHIELD | OTHER | 2009692000 | 01 | PA | AMERIHEALTH/INTERCOUNTY | OTHER | 30026851 | 01 | PA | KEYSTONE MERCY | OTHER | 2009692000 | 01 | PA | IBC - PC/KHPE | OTHER | 4643805 | 01 | PA | AETNA PPO | OTHER | 1044358 | 01 | PA | CIGNA HMO/PPO | OTHER | 0018564430022 | 05 | PA | MEDICAID |