Provider Demographics
NPI:1447353347
Name:THOMAS, ROBERTA M (ARNP)
Entity type:Individual
Prefix:MS
First Name:ROBERTA
Middle Name:M
Last Name:THOMAS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MISS
Other - First Name:ROBERTA
Other - Middle Name:JANE
Other - Last Name:MCTAGUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:243 ELM ST
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:NH
Mailing Address - Zip Code:03743-4921
Mailing Address - Country:US
Mailing Address - Phone:603-863-6400
Mailing Address - Fax:603-863-7800
Practice Address - Street 1:17 MAIN ST
Practice Address - Street 2:VALLEY REGIONAL PRIMARY CARE PHYSICIANS
Practice Address - City:NEWPORT
Practice Address - State:NH
Practice Address - Zip Code:03773-1504
Practice Address - Country:US
Practice Address - Phone:603-863-6400
Practice Address - Fax:603-863-7800
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH034524-23-03207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30343041Medicaid
VT1006587Medicaid
NH2309388YPNH01OtherANTHEM
NHNP1595Medicare PIN
NH2309388YPNH01OtherANTHEM