Healthcare Provider Details

I. General information

NPI: 1982908695
Provider Name (Legal Business Name): ABRAHAM THEKKANATTU THOMAS P.A.-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ABRAHAM THOMAS THEKKANATTU P.A.-C

II. Dates (important events)

Enumeration Date: 01/10/2011
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 WISCONSIN AVE
BETHESDA MD
20889-8442
US

IV. Provider business mailing address

3958 BRAVEHEART CIR
FREDERICK MD
21704-7743
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-8555
  • Fax: 301-400-0616
Mailing address:
  • Phone: 240-416-2327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0004293
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberC0004293
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: