Basic Information
| Provider Information | |||||||||
| NPI: | 1689788531 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THOMAS | ||||||||
| FirstName: | L. MARTHA | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | THOMAS | ||||||||
| OtherFirstName: | LATONA MARTHA | ||||||||
| OtherMiddleName: | ANN | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3421 CONCORD RD | ||||||||
| Address2: | |||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174029001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178512345 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1001 S GEORGE ST | ||||||||
| Address2: | |||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174033676 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178512345 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2006 | ||||||||
| LastUpdateDate: | 07/19/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 07/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | MD019947E | PA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 018745300 | 05 | MD | MEDICAID | 50069430 | 01 | PA | CAPITAL BLUE CROSS-WMG | OTHER | 3168158 | 01 | PA | MAMSI-WMG | OTHER | 212637 | 01 | PA | UNISON-WMG | OTHER | 212644 | 01 | PA | UNISON-YH | OTHER | 413171 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 8413 | 01 | PA | GEISINGER | OTHER | 20063010 | 01 | PA | AMERIHEALTH MERCY-WMG | OTHER | 000890997 | 05 | PA | MEDICAID | 1545481 | 01 | PA | GATEWAY | OTHER | 20063011 | 01 | PA | AMERIHEALTH MERCY-YH | OTHER | 246975 | 01 | PA | UNISON-WMG MFM | OTHER | 4598419 | 01 | PA | AETNA | OTHER | 30136945 | 01 | PA | AMERIHEALTH MERCY-YHOBGYN | OTHER | 50069428 | 01 | PA | CAPITAL BLUE CROSS-YH | OTHER | 897658 | 01 | MD | CAREFIRST MD BCBS | OTHER | 50079753 | 01 | PA | CAPITAL BLUE CROSS-WMG-MFM | OTHER |