MEDICARE: DR. MELVIN LAWRENCE THRASH M.D.

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	2084P0800X	Psychiatry Physician	126300	NY

General Provider Information

NPI Number	:	1598795239
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MELVIN LAWRENCE THRASH M.D.

Provider Business Mailing Address
First Line	:	3315 CHANATE RD
Second Line	:	SANTA ROSA VA MENTAL HEALTH CLINIC
City	:	SANTA ROSA
State	:	CA
Zip	:	95404-1736
Country	:	US
Telephone Number	:	707-570-3800
Fax Number	:	707-570-3860

Provider Business Practice Location Address
First Line	:	3315 CHANATE RD
Second Line	:	SANTA ROSA VA MENTAL HEALTH CLINIC
City	:	SANTA ROSA
State	:	CA
Zip	:	95404-1736
Country	:	US
Telephone Number	:	707-570-3800
Fax Number	:	707-570-3860

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

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	07/08/2007

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