1164658621 NPI number — MYCHAL LYNN ANDERSON THOMAS MD

Table of content: MYCHAL LYNN ANDERSON THOMAS MD (NPI 1164658621)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164658621 NPI number — MYCHAL LYNN ANDERSON THOMAS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANDERSON THOMAS
Provider First Name:
MYCHAL
Provider Middle Name:
LYNN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164658621
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/12/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1218 N WEST ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILMINGTON
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19801-1026
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-654-5349
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4755 OGLETOWN STANTON RD
Provider Second Line Business Practice Location Address:
DEPARTMENT OF OBSTETRICS AND GYNECOLOGY
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19718-2200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-690-9546
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/10/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  C1-0010553 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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