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NPI Code Detail

MEDICARE: DR. PREM THAMMAN MD

MEDICARE: DR. PREM THAMMAN MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician25641NJ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1609837905
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PREM THAMMAN MD
Provider Business Mailing Address
First Line : 361 GARIBALDI AVE
Second Line :
City : LODI
State : NJ
Zip : 07644-3709
Country : US
Telephone Number : 973-773-3556
Fax Number : 973-773-2337
Provider Business Practice Location Address
First Line : 361 GARIBALDI AVE
Second Line :
City : LODI
State : NJ
Zip : 07644-3709
Country : US
Telephone Number : 973-773-3556
Fax Number : 973-773-2337
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/28/2006
Last Update Date : 07/13/2010

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Directions to “ DR. PREM THAMMAN MD” Practice Location

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