Provider Demographics
NPI:1629052980
Name:THOMAS, ANGELA W (MD)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:W
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ANGELA
Other - Middle Name:K
Other - Last Name:WAMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-9403
Mailing Address - Country:US
Mailing Address - Phone:570-271-6472
Mailing Address - Fax:570-271-5874
Practice Address - Street 1:100 N ACADEMY AVE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17822-1302
Practice Address - Country:US
Practice Address - Phone:570-271-6472
Practice Address - Fax:570-271-5874
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4740682084N0400X
MS199792084N0400X
FLME1009652084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001653600Medicaid
AL142501Medicaid
FL146RZOtherBCBS
FLCR939UMedicare PIN