Healthcare Provider Details

I. General information

NPI: 1255869699
Provider Name (Legal Business Name): VINAY MATHEW THOMAS MBBS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2017
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date: 01/03/2018
Reactivation Date: 01/18/2018

III. Provider practice location address

30 N 1900 E RM 5C402
SALT LAKE CITY UT
84132-0002
US

IV. Provider business mailing address

30 N 1900 E RM 5C402
SALT LAKE CITY UT
84132-0002
US

V. Phone/Fax

Practice location:
  • Phone: 801-585-0120
  • Fax:
Mailing address:
  • Phone: 801-585-0120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number12256053-1205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number12256053-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: