Healthcare Provider Details

I. General information

NPI: 1952833931
Provider Name (Legal Business Name): THOMAS MARKUS FANDEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2017
Last Update Date: 07/09/2022
Certification Date: 07/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2690 S WHITE RD STE 50
SAN JOSE CA
95148-2075
US

IV. Provider business mailing address

2690 S WHITE RD STE 50
SAN JOSE CA
95148-2075
US

V. Phone/Fax

Practice location:
  • Phone: 408-223-7000
  • Fax: 408-223-7001
Mailing address:
  • Phone: 408-223-7000
  • Fax: 408-223-7001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberA-165033
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: