MEDICARE: CYRIAC THOMAS THACHET MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	MD045339L	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	110244602	OTHER	PA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4622304	OTHER	PA	AETNA PPO
2	538882	OTHER	PA	COVENTRY HEALTH AMERICA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	2776575	OTHER	PA	AETNA HMO
6	473238	OTHER	PA	AETNA HMO
7	1026843	OTHER	PA	KEYSTONE MERCY HEALTH
8	3Y3535	OTHER	PA	HEALTH NET
9	0546984000	OTHER	PA	INDEPENDENCE BLUE CROSS
10	1461	OTHER	PA	BRAVO HEALTH
11	710859	OTHER	PA	HIGHMARK BLUE SHIELD
12	1100949	OTHER	PA	KEYSTONE MERCY HEALTH

General Provider Information

NPI Number	:	1578547709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYRIAC THOMAS THACHET MD

Provider Business Mailing Address
First Line	:	PO BOX 820933
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19182-0933
Country	:	US
Telephone Number	:	215-425-2424
Fax Number	:	215-425-0342

Provider Business Practice Location Address
First Line	:	1741 FRANKFORD AVE
Second Line	:	SUITE 100A
City	:	PHILADELPHIA
State	:	PA
Zip	:	19125-2445
Country	:	US
Telephone Number	:	215-425-2424
Fax Number	:	215-425-0342

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2005
Last Update Date	:	12/12/2013

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