Individual
CYRIAC THOMAS THACHET
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1741 FRANKFORD AVE, SUITE 100A, PHILADELPHIA, PA 19125-2445
(215) 425-2424
(215) 425-0342
Mailing address
PO BOX 820933, PHILADELPHIA, PA 19182-0933
(215) 425-2424
(215) 425-0342
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD045339L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001273951
—
PA
01
—
0546984000
INDEPENDENCE BLUE CROSS
PA
01
—
1026843
KEYSTONE MERCY HEALTH
PA
01
—
1100949
KEYSTONE MERCY HEALTH
PA
01
—
110244602
RAILROAD MEDICARE
PA
01
—
1461
BRAVO HEALTH
PA
01
—
2776575
AETNA HMO
PA
01
—
3Y3535
HEALTH NET
PA
01
—
4622304
AETNA PPO
PA
01
—
473238
AETNA HMO
PA
01
—
538882
COVENTRY HEALTH AMERICA
PA
01
—
710859
HIGHMARK BLUE SHIELD
PA
Enumeration date
12/01/2005
Last updated
12/12/2013
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