Individual
CHAVANNES THOMAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
75 W 190TH ST, BRONX, NY 10468-5228
(718) 367-4488
(718) 367-0078
Mailing address
1028 FORDHAM LN, WOODMERE, NY 11598-1014
(718) 367-4488
(718) 367-0078
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
143387
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00591153
—
NY
Enumeration date
07/24/2006
Last updated
07/08/2007
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