Provider Demographics
NPI:1174993125
Name:ATTARDI, THOMAS (MA,NMT)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:ATTARDI
Suffix:
Gender:M
Credentials:MA,NMT
Other - Prefix:
Other - First Name:THOMAS
Other - Middle Name:
Other - Last Name:ATTARDI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, NMT
Mailing Address - Street 1:2400 LAS GALLINAS AVE STE 165
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-1458
Mailing Address - Country:US
Mailing Address - Phone:415-722-3066
Mailing Address - Fax:
Practice Address - Street 1:2400 LAS GALLINAS AVE STE 165
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-1458
Practice Address - Country:US
Practice Address - Phone:415-722-3066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-02
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA$$$$$$$$$AMedicare PIN