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General NPI Number Information
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NPI Number | 1770505570
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Entity Type | Individual
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Provider Name | CHAVANNES THOMAS M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/24/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 75 W 190TH ST
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City | BRONX
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State | NY
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Zip | 10468-5228
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Country | US
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Telephone | 718-367-4488
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Fax | 718-367-0078
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Provider Business Mailing Address
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Address Line | 1028 FORDHAM LN
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City | WOODMERE
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State | NY
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Zip | 11598-1014
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Country | US
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Telephone | 718-367-4488
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Fax | 718-367-0078
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 143387
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License Number State | NY
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