Provider Demographics
NPI:1447838107
Name:THOMAS, TEENA (MD)
Entity type:Individual
Prefix:
First Name:TEENA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3423 DANBURY RD
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:NY
Mailing Address - Zip Code:10509-4513
Mailing Address - Country:US
Mailing Address - Phone:845-279-7200
Mailing Address - Fax:203-739-1883
Practice Address - Street 1:3423 DANBURY RD
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:NY
Practice Address - Zip Code:10509-4513
Practice Address - Country:US
Practice Address - Phone:845-279-7200
Practice Address - Fax:203-739-1883
Is Sole Proprietor?:No
Enumeration Date:2021-04-01
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT78203207R00000X
NY331714207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine