Healthcare Provider Details

I. General information

NPI: 1730470014
Provider Name (Legal Business Name): THOMAS ALEXANDER SUBERMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2011
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1360 E LASSEN AVE
CHICO CA
95973-7823
US

IV. Provider business mailing address

206 SPRUCE ST
PHILADELPHIA PA
19106-4307
US

V. Phone/Fax

Practice location:
  • Phone: 530-267-1700
  • Fax:
Mailing address:
  • Phone: 917-583-3577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA135689
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: