MEDICARE: DR. MICHAEL E THASE 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
1	2084P0800X	Psychiatry Physician	MD024464E	PA
2	102L00000X	Psychoanalyst	MD024464E	PA
3	174400000X	Specialist	MD024464E	PA

Other Identifiers

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

General Provider Information

NPI Number	:	1982670279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL E THASE MD

Provider Business Mailing Address
First Line	:	3535 MARKET ST.
Second Line	:	3RD FLOOR
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-2617
Country	:	US
Telephone Number	:	215-746-6700
Fax Number	:	215-746-5155

Provider Business Practice Location Address
First Line	:	3535 MARKET STREET
Second Line	:	3RD FLOOR
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-3309
Country	:	US
Telephone Number	:	215-746-6700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2006
Last Update Date	:	10/10/2012

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