=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760599138
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PRAKASH K. THOMAS M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/23/2006
-----------------------------------------------------
Last Update Date | 06/19/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 303 WHITNEY AVE STE 8
-----------------------------------------------------
City | NEW HAVEN
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06511-7206
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-500-5499
-----------------------------------------------------
Fax | 203-453-2704
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 303 WHITNEY AVE STE 8
-----------------------------------------------------
City | NEW HAVEN
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06511-7206
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-500-5499
-----------------------------------------------------
Fax | 203-453-2704
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 042589
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2084P0804X
-----------------------------------------------------
Taxonomy Name | Child & Adolescent Psychiatry Physician
-----------------------------------------------------
License Number | 042589
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------